RUNNING A DIABETIC CLINIC

IN A LARGE GROUP PRACTICE

SUSAN NEAL

NURSE PRACTITIONER

DIABETICS AT NSMC

• 12,500 patients

• Register of 403 (3.2%)

• Type 1 = 40 (10%)

• Type 2 = 357(90%)

• Approx 40 Type 2 are Insulin dependant

WORKLOAD

• 344 patients attending DC

• Type 1 = 31(78%) seen DC in last 15m

• Type 2 = 317(90%)seen DC in last 15m

• Other 60 mixture of hosp/recidivists/housebound

• 896 dedicated diabetic or DC/CVS appts (17 appts weekly)

• 2/3 appts annually on average

• 4 clinicians

USING A PATIENT TO ILLUSTRATE THE POINTS

FEMALEBORN 1955

OBESEPOSSIBLE ANGINA 1991

FH OF DM (MOTHER)

WHAT ARE THE REQUIREMENTS?

PROTOCOL FOR ALL NURSES AND DOCTORS

AGREED APPROACH TO MANAGEMENT

EFFECTIVE USE OF IT – Protocol to include consistent IT entries

TARGETS FOR BP CONTROL

TARGETS FOR HbA1c LEVELS

AGREEMENT ON OTHER INVESTIGATIONS

FIT WITH NSF / NEW CONTRACT?

STEPPED APPROACH TO MEDICATION

NOT TO MAKE THINGS DIFFICULTEXPERTISE AND CONFIDENCE

CAN BE DEVELOPED IN HOUSEAPPROPRIATE USE OF EXPERTS –

DSNs, HOSPITAL CLINICS, DIETICIANS

DISEASE REGISTER

ADMIN USE OF REGISTER/RECALL

MONITOR LEVEL OF CARE BEING

DELIVERED

AUDIT AND QUALITY CONTROL

Keep things simple & Keep things simple & straightforwardstraightforward

Does not need to be done Does not need to be done all in one go!all in one go!

Use advice and supportUse advice and support