pediatric assessment part 2...
TRANSCRIPT
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PEDIATRIC ASSESSMENT
PART 2 – FOLLOW-UP
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GOALS
• Consistent approach to assessing pediatric patients with Type 1 or Type 2diabetes across Nova Scotia
• One form that can be used for pumpers and non pumpers
Consistency
• To collect all information required to provide the best possible care to a pediatric patient and their family
• Gather all information required for DCPNS data base
Information
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HIGHLIGHTS
Name: Date: Non-NSIPP NSIPP
Duration of diabetes/Age at onset: Current age: Type 1 Type 2 Other
Accompanied by: mother father sibs: other:
Lives with: mother father other:
Information obtained from: mother father child other:
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MEAL TIMES COMMENTS
Basal (%):
Bolus (%):
Bkfst AM Lunch PM Supper HS (e.g., changes in activity, insulin adjustment, omits, takes when ill, skips meals, etc.)
Usual
Weekend/OtherBASAL RATES:
Time Rate
TYPE OF INSULIN
and/or
Non-Insulin Therapy
DOSAGE and/or CHO/Ratio
ISF: ACTIVE INSULIN TIME: TOTAL UNITS: U/kg:
Glucose Targets: Uses Bolus Calculator: N Y Inject/Bolus before meals: N Y
How often are insulin/boluses missed? Avg. Bolus per day:
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INSULIN N/A INSTRUCTED (see Education Checklist)
Prepared by: mother father child other:
Injected by: mother father child other:
Supervised by: mother father other:
Appropriate technique: N Y not observed
Sites used: buttock R L leg R L arm R L
abdomen R L calf (if applicable) R L
Appropriate site rotation: N Y
How often is the site changed? Daily Every 2 to 3 days Every 3 to 5 days Every 5 days or more
Lipodystrophy: N Y
Adjusts insulin: N Y
INSULIN
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BLOOD GLUCOSE MONITORING N/A INSTRUCTED (see Education Checklist)
Tested by: mother father child other:
Recorded by: mother father child other:
Supervised by: mother father other:
Appropriate technique: N Y not observed Do you download regularly? N Y Details: Did you download your pump today? N Y
TIMERESULTS
Based on days
Based on: Record book Verbal report
Computer printout/download
AC 2-hr COMMENTS (e.g. weekend variations, range, etc.)
Bkfst
Lunch
Supper
hs
12 AM
3 AM
Interprets results and acts appropriately: N Y
Method: Frequency/day/week:_____________________ Tests ≥ 4x/day
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HYPOGLYCEMIA Diabetes ID: N Y
SYMPTOMS: headache moody weak
shaky hungry sweaty
pallor nightmares dizzy other: none
Are symptoms recognized by the child? N Y N/A
MILD (frequency, times):
Treatment Appropriate? N Y What treatment does the child/adolescent carry? MODERATE/SEVERE (Severe hypoglycemia is defined as unable to help self): Y (see below) N
Date Treated by: 1) Care giver/family 2) EHS only 3) Emergency Dept. 4) Admission
Treated with glucagon
(√)
What was the cause of moderate/severe hypoglycemia (note number): 1) Exercise; 2) Insulin error; 3) Missed/late meal; 4) Slept in; 5) Alcohol; 6) Other (please note reason)
Glucagon at home: N Y Expiry date checked: N Y Prescription: N Y
SCHOOL PLAN IN PLACE: Y N Grade in school: INSTRUCTED (see Education Checklist)
Is school prepared to treat? N Y Has teacher been given appropriate information? N Y
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ACTIVITY INSTRUCTED (see Education Checklist)
What types of exercise/activity do you do? None Screen time:
Please list:
What adjustments are made to insulin/food for exercise(s)? n/aTemporary basal rates Suspend pump Carb coverage Decrease bolus
Extra monitoring Insulin Adjustment Snack None
ACTIVITY
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SICK DAYS INSTRUCTED (see Education Checklist)
Illness since last visit: N Y
Number of days sick:
Describe blood glucose problems when ill:
Diabetes symptoms: polyuria nocturia (___/night) headaches polydipsia enuresis Other:
Abdominal symptoms:
Ketones Checked: N Y When: By whom:
Ketones Testing: appropriate inappropriate never Expiry date checked: N Y
Action taken: appropriate inappropriate never
Date Treated in Hospital
Treated in Emergency
What was the cause of the DKA (note number)? 1) Insulin omission; 2) Illness; 3) Pump/Pump site failure; 4) Insufficient monitoring; 5) Other (please note reason)
DKA Since Last Visit Y (see below) N
SICK DAYS
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SOCIAL ASSESSMENT
SOCIAL ASSESSMENT INSTRUCTED (see Education Checklist)
Smoking: N Y Amount: Willing to reduce/quit
Social drugs: N Y Type/freq:
Alcohol: N Y Type/amount/freq:
Sexually active: N Y Birth control:
STD prevention: N Y
Driving: N Y Safe practices: N Y n/a
Days missed from school since last visit:
School concerns/performance:
Family concerns/involvement/changes:
Religious, family, or cultural practices that may influence how child/family cares for health:
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NUTRITIONAL ASSESSMENT
NUTRITION--DIETITIAN ONLY (for known patient or new referral if appropriate)
CHO counting: N Y Present meal plan (KJ/calories):
Meal plan: appropriate inappropriate Compensation for activities: appropriate inappropriate
Meal/snack timing: appropriate inappropriate School concerns: N Y
Treatment for hypoglycemia: appropriate inappropriate
Notable eating patterns: food restrictive behaviour overindulgence
Explain:
Comments:
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QUESTIONS AND COMMENTS
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Insulin Pump Follow-Up Form Update
Carrie Haggett RN BScN CDE
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Objectives:
1. To review the history of the Insulin Pump Follow-Up form.
2. Review how the form was designed.3. Review the layout of the form.4. Give your input for the forms
improvement.
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Insulin Pump Follow-up Form
• Concept designed in Sept 2012• Concept re-visited in June of 2014 we
started working with various NSIPP approved sites to develop a form that would allow patient self completion, capture the information needed for NSIPP renewal in the registry and assist educators who aren’t as familiar with pump therapy
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• Current Insulin Pump Follow-up form dated Sept 2014
• Introduced at the DCPNS Pump Education Day in Nov 2014
• Please use for 1 year and than give us your feedback in Nov 2015.
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Top of Page 1 of the Insulin Pump Follow-up FormINSULIN PUMP FOLLOW-UP FORM (Pages 1, 2 & 3 to be completed by patient/family) To help us make the most of your visit, please take a few minutes to complete this form. Please do not fill in the shaded area on page 3 & p age 4.
If there are parts you are unsure of, please leave blank and discuss with your team.
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Page 1 & 2…• Are there other things you would like to
talk about (please check the most important ones)?
• Activity• Hypoglycemia• Self Monitoring of Blood Glucose• Goals• Sexual Health
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Page 3…• Did you download your pump today?• Which Pump and Infusion set do you use?• What are your sites like and how often do
you change sites?• Basal insulin: insulin type and rates• Bolus: ICR and BG targets and • TDD, ISF and Active Insulin Time• Nutrition Notes (shaded)
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Page 4…To be completed by Healthcare Providers• Hypoglycemia• DKA• B/P,Ht,Wt• Current A1C, Last A1C, A1C goal• School/Daycare plan in Place• Notes for Dietitian, Nurse, Physician
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Let’s hear from you …
• If you have used the form and you have some constructive input to make the form more user friendly please submit your comments to…
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Partnerships, Quality, and Innovation (since 1991)
DCPNS Registry EnhancementsPump Day 2015
November 13, 2015
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23Partnerships, Quality, and Innovation (since 1991)
DCPNS Registry – Medical Eligibility Criteria
● # DC visits, # A1Cs in last 12m (and the values), Goal A1C,
SMBG Freq & Use, DKAs, and S/Dcare plan at top of pump tab
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24Partnerships, Quality, and Innovation (since 1991)
DCPNS Registry – Easier Entry
● No more extra clicks – just check the appropriate box/circle
– Enter Pump Start here & it will also appear under Present
Treatment & vice versa
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25Partnerships, Quality, and Innovation (since 1991)
DCPNS Registry – Easier Entry
● Medical Eligibility (ME) area is always visible
– Critical to complete – populates the NSIPP side with the ME date
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Partnerships, Quality, and Innovation (since 1991)
Thank-youQuestions?