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A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.
Sarah: Are you interested
in team based primary care?
Are you hoping that adding a nurse
to your team can help chronic
disease care like diabetes?
Do you want to learn more?
Yeah, me too.
Okay, Morgan, I'm
excited for this episode.
Last year, Kacey joined the
Innovation Support Unit, and she's a
certified diabetes education nurse.
I know this is a real area of passion
for her, and I'm dying to hear what she
had to say about how nurses can help with
diabetes care in team based primary care.
Morgan SM7b-MixPre: Yeah, Sarah, I really
enjoyed chatting with Kacey and everyone
about how they see team based primary
care specifically around diabetes care.
It was particularly great to hear more
of Kacey's expertise in this area.
I got to see a different side to
Kacey outside of her usual ISU
teamwork.
Sarah: You know, Kacey and I have had
some great conversations about diabetes
and the question of where diabetes
care fits into the healthcare system.
it's common, it's managed
a lot in, primary care.
Morgan SM7b-MixPre: Yeah, the
majority of diabetes care in
Canada is done in primary care.
And in a team, done with a
nurse, I think more can be done
in primary care with a higher
functioning team.
Sarah: So what do you want to
talk about in this episode?
Morgan SM7b-MixPre: Well, within
diabetes care today, how about we
talk about where's an easy place to
start with a new nurse in your team?
And then how nursing supports
streamlined follow up care.
And then we can get specific and
highlight foot care for diabetics.
Sarah: Great.
So let's start at the beginning.
A clinic has recently hired a new nurse.
Where could the nurse
start with diabetes care?
See you
Morgan SM7b-MixPre: I think for
newer teams who are still figuring
out a little bit about how they're
working together, I think an easy
place to start is patient education.
And Kacey agreed.
Kacey: where I think they could start.
is providing some basic education
around diabetes, sort of Diabetes 101.
So Diabetes Canada has lots of resources.
So even just, having the nurse use
those resources to help support
patients learning more about diabetes
would be a really good thing.
The other thing I think a
primary care nurse, regardless of
experience, can be super valuable
is connecting people to resources.
Sarah: I like that, and I think, as
a patient, I would feel comfortable
seeing a new member of my primary
care team for some education
on, on something like diabetes,
Morgan SM7b-MixPre: Yeah, that's a good
point to being the patient's perspective.
It's low stakes and a way for a nurse to
develop a relationship with a patient.
And I think that'll then really help with
future care.
Sarah: and I'm imagining that
education could be a good introduction
at any time for a new nurse.
Morgan SM7b-MixPre: Yeah.
And education could be
for a range of things too.
It doesn't just have to be for
patients who are newly diagnosed.
It could be about diabetes and
lifestyle or diabetes medication
or, uh, adjustments to diet.
There's lots of educational
components that could be that
first visit with a new nurse.
Sarah: So now let's talk about
how nursing supports can really
streamline follow up care.
let's shift to that.
Morgan SM7b-MixPre: as a team, I
think you can share the follow up
of patients and for people with
diabetes, it's a great way to work
together.
Sarah: So how would that work exactly?
Okay.
Morgan SM7b-MixPre: I'll let the expert,
I'll let Kacey explain her approach.
Kacey: So as an RN, I can't
independently order lab work, right?
So the doctor will always
have to order lab work.
What I can do is I can review lab work.
So as an RN, I can triage, as you
would, the lab work that needs to be
dealt with sooner rather than later.
So if I see an abnormal value
that needs to be acted on,
I can connect to the doctor.
If it's within normal ranges,
and it's expected, I would send a
message to the doctor saying lab
work is back, they're good to go.
I'm going to meet with them in
three months, or I'm going to meet
with them next week to review it.
Morgan SM7b-MixPre: So, Sarah,
for me, it's that triaging of
results and planning the follow up.
Those things can be so
helpful.
Sarah: Right, because you could
look through the labs and your
EMR says normal or abnormal.
Morgan SM7b-MixPre: Right, but to
know that Kacey's used her clinical
judgment and decided it's normal for
that person, and we both know and have
confirmed follow up, that's teamwork.
Sarah: And Morgan, can I circle back to
something else that Kacey said there?
I thought that RNs could order blood work.
Morgan SM7b-MixPre: Yeah, sometimes.
So, it, depends on training, and
which tests we're talking about.
would double check with the official scope
documents to confirm exactly, of course.
and I think the best thing to do
is to talk about it as a team.
If there are specific tests for patients,
then you can create standing orders.
So you can put those into
a care plan, for example.
And so for diabetes, you could put
together a protocol and have a standing
order in the chart for diabetic patients
that you're sharing with a nurse.
And that way the nurse can follow up
with a patient, Using that standing
order every three or six months
Sarah: and if something changes.
Morgan SM7b-MixPre: well, teamwork,
of course, I mean, you talk
about it and, change the orders.
Sarah: Morgan, you didn't talk about
nurses creating kind of recall lists
and calling the patients in when
we're thinking about follow up.
why didn't you talk about that?
That comes up a lot in
our team mapping sessions.
Morgan SM7b-MixPre: Yeah,
Sarah, it does, doesn't it?
And, I didn't on purpose.
I think a nurse can absolutely do that.
Overall, you want to think
of the trajectory of care
and recalling in patients is
something that's really important.
But I also think there's another team
member in just about every office that
can really do a lot of this coordination
and recalls, and that's the MOA.
I think the office assistant can do a
lot of the mechanics of generating the
recall list, calling back patients who are
overdue for a three or six month checkup.
that's kind of why I didn't
jump to that as an example.
I think.
The, nurse can review the recall
list, and perhaps figure out
who really needs to be seen.
So there's a little bit of a sort
of a triage there, but, I think
the MOA has a, big role in that
as well.
Sarah: that's a great point.
Don't forget who's already part of your
team when you're thinking about how
you work together on working together.
Morgan SM7b-MixPre: Yeah,
exactly.
Sarah: So, for our third idea
here, Morgan, you really wanted
to talk about feet and foot care.
Why?
That's not what I think about
when I think about diabetes.
Morgan SM7b-MixPre: I know.
I know.
And I think most people who
haven't had the clinical
training might not think of it.
But, checking feet and overall foot
care is actually really important.
we want to reduce the risk of
amputation in diabetics and diabetes
is the main cause of non traumatic
amputation in North America.
Nurses have all the expertise to help
patients better manage their feet.
And that, reduces the risk
of, future amputation.
So, Hannah, the Kool Aid nurse that
I work with, flagged foot care as an
important component of diabetes care.
Hannah: Another thing is foot care.
So.
I think that is so crucial for diabetics,
yet we knew that was really important
with neuropathy and things like that.
RNs can be trained to do foot care.
especially for our older generation
population with diabetes, you know,
bending over for them to look at
their feet can be really challenging.
Morgan SM7b-MixPre: With the right skills
for foot care, it then becomes one part
of the overall diabetes follow up visit.
Hannah: having an appointment, you do
their blood work, you check their sugars
record, you know, you're looking at
their feet, to make sure that there's
nothing developing or any wounds.
Sarah: And it really sounds
like it becomes a pretty
comprehensive visit really quickly.
Morgan SM7b-MixPre: Yeah, it would.
And if there's anything that a nurse
practitioner or family doctor might
need to add to that, then you can pop
in and do a mini assessment, write a few
prescriptions.
Sarah: And if there's anything
on the feet to be worried about,
Morgan SM7b-MixPre: Well then, Hannah is
an expert in complex wound care as well.
I mean, so much more than I am.
And so the patient's feet are,
quite literally in good hands.
Hannah provides all the care
needed to address a complex wound.
Tons of chronic wounds, and if there is
an ulcer on the foot, then it's covered.
Sarah: got it.
Morgan SM7b-MixPre: So, Sarah, I
have got one last thought from Kacey.
Maybe this should have come first
in the episode, but not every nurse
comes with the same experience as
she does, particularly with diabetes.
Kacey: I think
for diabetes, because it's such, a
large area to begin with, I think one
of the biggest pieces is finding out
where your nurse is at in terms of
their comfort level supporting that.
There are some nurses, like myself,
if you brought someone in that has,
experience in diabetes, you can
employ them right out of the get go.
Morgan SM7b-MixPre: So if you know
your patients need primary care
nursing for diabetes, Then include
that experience as a criteria as you're
hiring.
Sarah: Or I guess you could grow
this capacity in the team with a new
nurse with extra education, right?
Morgan SM7b-MixPre: Absolutely.
You just need to plan for it.
Sarah: And Morgan, thinking with my
team mapping hat on, you kind of missed
care coordination outside of the team.
Nurses could do this for
diabetic patients too.
We often see like a diabetes
education center pop up on
the outside of our team maps.
Morgan SM7b-MixPre: Yeah, absolutely.
If there's a strong diabetes education
center, education nurse in your
community, you don't need to, duplicate
it or, Compete against the good nurse
in the diabetes education center.
A nurse in your practice could
absolutely coordinate outside to
the primary care team as well.
I skipped it.
Not because I think it's unimportant
because I wanted to highlight
some of those other areas.
And I think with a nurse in the team,
you're probably doing a bit more in house
than having to coordinate outside your
primary care clinic.
Sarah: That's a good point.
You know, you're a team, you're the
patient medical home, you do whatever
you can do with those, those team
members that you have inside that
team, and then step outside to kind of
coordinate with the community as needed.
Morgan SM7b-MixPre: And that seems
like a great place to wrap up this
episode about some of the ways primary
care nurses can support patients with
diabetes.
Sarah: We'll see you next time on Team Up.
Thanks for listening.
Morgan SM7b-MixPre: you have any
questions or topic suggestions,
please email us at isu at familymed.
ubc.
ca.
Sarah: The Innovation Support Unit is
a distributed multidisciplinary team.
We work mostly remotely from communities
across the Lower Mainland and
Vancouver Island in British Columbia.
Morgan: Sarah and I are both recording
from our offices in the territories
of the Lekwungen speaking peoples, the
Songhees and Esquimalt First Nations.
Sarah: And recognizing the colonial
history and the ongoing impacts of
colonization and healthcare systems
and in Indigenous communities in
Canada and around the world, as we
move through the season, we'll work
to bring an equity lens to this work.
And we really encourage you, our
listener, to reflect on your past,
present, and future participation.
On the indigenous lands
where you are situated.
Morgan: we'll see you in
the next episode of team up.