0:00

Sarah: Are you interested in team based primary care?

0:02

Are you hoping that adding a nurse to your team can help chronic

0:04

disease care like diabetes? Do you want to learn more?

0:08

Yeah, me too. Okay, Morgan, I'm excited for this episode.

0:44

Last year, Kacey joined the Innovation Support Unit, and she's a

0:46

certified diabetes education nurse.

0:49

I know this is a real area of passion for her, and I'm dying to hear what she

0:53

had to say about how nurses can help with diabetes care in team based primary care.

0:57

Morgan SM7b-MixPre: Yeah, Sarah, I really enjoyed chatting with Kacey and everyone

1:00

about how they see team based primary care specifically around diabetes care.

1:05

It was particularly great to hear more of Kacey's expertise in this area.

1:09

I got to see a different side to Kacey outside of her usual ISU

1:13

teamwork. Sarah: You know, Kacey and I have had some great conversations about diabetes

1:17

and the question of where diabetes care fits into the healthcare system.

1:21

it's common, it's managed a lot in, primary care.

1:24

Morgan SM7b-MixPre: Yeah, the majority of diabetes care in Canada is done in primary care.

1:27

And in a team, done with a nurse, I think more can be done

1:31

in primary care with a higher

1:33

functioning team. Sarah: So what do you want to talk about in this episode?

1:37

Morgan SM7b-MixPre: Well, within diabetes care today, how about we

1:39

talk about where's an easy place to start with a new nurse in your team?

1:44

And then how nursing supports streamlined follow up care.

1:48

And then we can get specific and highlight foot care for diabetics.

1:52

Sarah: Great. So let's start at the beginning.

1:55

A clinic has recently hired a new nurse.

1:58

Where could the nurse start with diabetes care?

2:00

See you Morgan SM7b-MixPre: I think for newer teams who are still figuring

2:04

out a little bit about how they're working together, I think an easy

2:07

place to start is patient education.

2:10

And Kacey agreed. Kacey: where I think they could start.

2:14

is providing some basic education around diabetes, sort of Diabetes 101.

2:21

So Diabetes Canada has lots of resources.

2:24

So even just, having the nurse use those resources to help support

2:30

patients learning more about diabetes would be a really good thing.

2:35

The other thing I think a primary care nurse, regardless of

2:39

experience, can be super valuable is connecting people to resources.

2:45

Sarah: I like that, and I think, as a patient, I would feel comfortable

2:48

seeing a new member of my primary care team for some education

2:51

on, on something like diabetes, Morgan SM7b-MixPre: Yeah, that's a good point to being the patient's perspective.

2:56

It's low stakes and a way for a nurse to develop a relationship with a patient.

3:00

And I think that'll then really help with future care.

3:03

Sarah: and I'm imagining that education could be a good introduction

3:06

at any time for a new nurse. Morgan SM7b-MixPre: Yeah.

3:08

And education could be for a range of things too.

3:10

It doesn't just have to be for patients who are newly diagnosed.

3:13

It could be about diabetes and lifestyle or diabetes medication

3:17

or, uh, adjustments to diet. There's lots of educational components that could be that

3:22

first visit with a new nurse. Sarah: So now let's talk about how nursing supports can really

3:27

streamline follow up care. let's shift to that.

3:31

Morgan SM7b-MixPre: as a team, I think you can share the follow up

3:34

of patients and for people with diabetes, it's a great way to work

3:39

together. Sarah: So how would that work exactly?

3:42

Okay. Morgan SM7b-MixPre: I'll let the expert, I'll let Kacey explain her approach.

3:45

Kacey: So as an RN, I can't independently order lab work, right?

3:50

So the doctor will always have to order lab work.

3:53

What I can do is I can review lab work.

3:57

So as an RN, I can triage, as you would, the lab work that needs to be

4:02

dealt with sooner rather than later.

4:05

So if I see an abnormal value that needs to be acted on,

4:09

I can connect to the doctor.

4:12

If it's within normal ranges, and it's expected, I would send a

4:17

message to the doctor saying lab work is back, they're good to go.

4:21

I'm going to meet with them in three months, or I'm going to meet with them next week to review it.

4:25

Morgan SM7b-MixPre: So, Sarah, for me, it's that triaging of

4:27

results and planning the follow up.

4:30

Those things can be so helpful. Sarah: Right, because you could look through the labs and your

4:35

EMR says normal or abnormal.

4:38

Morgan SM7b-MixPre: Right, but to know that Kacey's used her clinical

4:40

judgment and decided it's normal for that person, and we both know and have

4:44

confirmed follow up, that's teamwork. Sarah: And Morgan, can I circle back to something else that Kacey said there?

4:50

I thought that RNs could order blood work.

4:54

Morgan SM7b-MixPre: Yeah, sometimes. So, it, depends on training, and which tests we're talking about.

4:59

would double check with the official scope documents to confirm exactly, of course.

5:03

and I think the best thing to do is to talk about it as a team.

5:06

If there are specific tests for patients, then you can create standing orders.

5:11

So you can put those into a care plan, for example.

5:14

And so for diabetes, you could put together a protocol and have a standing

5:18

order in the chart for diabetic patients that you're sharing with a nurse.

5:21

And that way the nurse can follow up with a patient, Using that standing

5:24

order every three or six months Sarah: and if something changes.

5:27

Morgan SM7b-MixPre: well, teamwork, of course, I mean, you talk

5:30

about it and, change the orders.

5:32

Sarah: Morgan, you didn't talk about nurses creating kind of recall lists

5:35

and calling the patients in when we're thinking about follow up.

5:38

why didn't you talk about that? That comes up a lot in our team mapping sessions.

5:42

Morgan SM7b-MixPre: Yeah, Sarah, it does, doesn't it? And, I didn't on purpose.

5:46

I think a nurse can absolutely do that.

5:48

Overall, you want to think of the trajectory of care

5:51

and recalling in patients is something that's really important.

5:54

But I also think there's another team member in just about every office that

5:58

can really do a lot of this coordination and recalls, and that's the MOA.

6:02

I think the office assistant can do a lot of the mechanics of generating the

6:08

recall list, calling back patients who are overdue for a three or six month checkup.

6:12

that's kind of why I didn't jump to that as an example.

6:15

I think. The, nurse can review the recall list, and perhaps figure out

6:20

who really needs to be seen. So there's a little bit of a sort of a triage there, but, I think

6:24

the MOA has a, big role in that as well. Sarah: that's a great point.

6:28

Don't forget who's already part of your team when you're thinking about how

6:31

you work together on working together. Morgan SM7b-MixPre: Yeah,

6:33

exactly. Sarah: So, for our third idea here, Morgan, you really wanted

6:37

to talk about feet and foot care. Why?

6:40

That's not what I think about when I think about diabetes.

6:42

Morgan SM7b-MixPre: I know. I know. And I think most people who haven't had the clinical

6:46

training might not think of it. But, checking feet and overall foot care is actually really important.

6:52

we want to reduce the risk of amputation in diabetics and diabetes

6:55

is the main cause of non traumatic amputation in North America.

7:00

Nurses have all the expertise to help patients better manage their feet.

7:04

And that, reduces the risk of, future amputation.

7:07

So, Hannah, the Kool Aid nurse that I work with, flagged foot care as an

7:11

important component of diabetes care. Hannah: Another thing is foot care.

7:14

So. I think that is so crucial for diabetics, yet we knew that was really important

7:19

with neuropathy and things like that. RNs can be trained to do foot care.

7:24

especially for our older generation population with diabetes, you know,

7:28

bending over for them to look at their feet can be really challenging.

7:32

Morgan SM7b-MixPre: With the right skills for foot care, it then becomes one part

7:35

of the overall diabetes follow up visit.

7:38

Hannah: having an appointment, you do their blood work, you check their sugars

7:41

record, you know, you're looking at their feet, to make sure that there's

7:45

nothing developing or any wounds.

7:48

Sarah: And it really sounds like it becomes a pretty comprehensive visit really quickly.

7:52

Morgan SM7b-MixPre: Yeah, it would. And if there's anything that a nurse practitioner or family doctor might

7:58

need to add to that, then you can pop in and do a mini assessment, write a few

8:01

prescriptions. Sarah: And if there's anything on the feet to be worried about,

8:05

Morgan SM7b-MixPre: Well then, Hannah is an expert in complex wound care as well.

8:08

I mean, so much more than I am. And so the patient's feet are, quite literally in good hands.

8:13

Hannah provides all the care needed to address a complex wound.

8:16

Tons of chronic wounds, and if there is an ulcer on the foot, then it's covered.

8:21

Sarah: got it. Morgan SM7b-MixPre: So, Sarah, I have got one last thought from Kacey.

8:26

Maybe this should have come first in the episode, but not every nurse

8:30

comes with the same experience as she does, particularly with diabetes.

8:34

Kacey: I think for diabetes, because it's such, a large area to begin with, I think one

8:41

of the biggest pieces is finding out where your nurse is at in terms of

8:46

their comfort level supporting that. There are some nurses, like myself, if you brought someone in that has,

8:53

experience in diabetes, you can employ them right out of the get go.

8:56

Morgan SM7b-MixPre: So if you know your patients need primary care

8:59

nursing for diabetes, Then include that experience as a criteria as you're

9:04

hiring. Sarah: Or I guess you could grow this capacity in the team with a new

9:07

nurse with extra education, right?

9:10

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

9:16

care coordination outside of the team.

9:18

Nurses could do this for diabetic patients too.

9:20

We often see like a diabetes education center pop up on

9:24

the outside of our team maps. Morgan SM7b-MixPre: Yeah, absolutely.

9:27

If there's a strong diabetes education center, education nurse in your

9:30

community, you don't need to, duplicate it or, Compete against the good nurse

9:35

in the diabetes education center. A nurse in your practice could absolutely coordinate outside to

9:41

the primary care team as well. I skipped it.

9:43

Not because I think it's unimportant because I wanted to highlight

9:47

some of those other areas. And I think with a nurse in the team, you're probably doing a bit more in house

9:52

than having to coordinate outside your primary care clinic.

9:55

Sarah: That's a good point. You know, you're a team, you're the patient medical home, you do whatever

10:00

you can do with those, those team members that you have inside that

10:03

team, and then step outside to kind of coordinate with the community as needed.

10:07

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

10:12

diabetes. Sarah: We'll see you next time on Team Up.

10:16

Thanks for listening. Morgan SM7b-MixPre: you have any questions or topic suggestions,

10:19

please email us at isu at familymed.

10:22

ubc. ca. Sarah: The Innovation Support Unit is a distributed multidisciplinary team.

10:31

We work mostly remotely from communities across the Lower Mainland and

10:34

Vancouver Island in British Columbia. Morgan: Sarah and I are both recording from our offices in the territories

10:40

of the Lekwungen speaking peoples, the Songhees and Esquimalt First Nations.

10:44

Sarah: And recognizing the colonial history and the ongoing impacts of

10:48

colonization and healthcare systems and in Indigenous communities in

10:51

Canada and around the world, as we move through the season, we'll work

10:54

to bring an equity lens to this work. And we really encourage you, our listener, to reflect on your past,

11:00

present, and future participation. On the indigenous lands where you are situated.