GREATER NEWCASTLE SECTOR DIABETES SERVICE
GNS Diabetes Service
Diabetes Staff Orientation Guide
January 2020
Welcome to the Team
Welcome to the Greater Newcastle Sector Diabetes Service. The service is part of Community and Aged Care Services (CACS) in the Greater Newcastle Sector (GNS) – one of the seven Hunter New England Local Health District (HNELHD) sectors. The service also supports adult diabetes medical clinics at John Hunter, Belmont and Maitland Hospitals.
New employees to the Diabetes Service will also be provided with a copy of the Hunter New England Local Health District Orientation Guide for New Staff, as it contains generic information about working in our health service and the CACS-GNS Orientation Guide for New Staff, containing information about the Greater Newcastle Sector. It is recommended that the HNELHD Guide is read first, with the CACS-GNS Guide and this service orientation guide providing local and additional information to support you in your role.
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About this Orientation Guide
. Information can be used for the orientation of new staff to Greater Newcastle Sector Diabetes Service and for existing staff to update on procedures. . New and existing staff can use the checklists that accompany this guide to monitor their training progress and competency, and participate in ongoing review. . New staff will be allocated an orientation buddy to help guide them through the orientation process.
Contents of this guide . Information about the adult diabetes services offered. . Minimum Standards of Care in GNS Diabetes Service. . General Information about GNS Diabetes Service. . Administrative and Clinical Procedures. . Diabetes Service procedures and site orientation to Newcastle Community Health Centre (NCHC), 670 Hunter Street Newcastle and other site locations where you may work. . Diabetes Clinics procedures at the Royal Newcastle Centre (RNC) on the John Hunter Campus. . Diabetes Service procedures at other community sites. . General Checklist Diabetes Service (CHIME). . Diabetes Service Combined Foot Clinic. . Meter and Pump Downloading.
Philosophy of the Diabetes Team
The GNS Diabetes Service bases professional practice on all staff working together cooperatively as a supportive, multi-disciplinary team. The team takes a holistic approach to patient self- management education to motivate the patient, and their carers/support persons and health care professionals to develop a realistic care plan for the patient.
The diabetes staff believe that better diabetic control and minimisation of complications can be achieved by incorporating assessment, monitoring, education and counselling, follow-up and on- going support.
The Diabetes Service is a multidisciplinary team committed to fostering independence of the person with diabetes and improving the lifestyle of the person with diabetes and their relatives/support persons. The right of patients to select their health care professionals, be involved in planning their own education program, and be informed of their progress, is respected and encouraged.
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Adult Diabetes Services in the Greater Newcastle Sector
Royal Newcastle Centre (RNC) John Hunter Hospital, Level 2 North Block RNC Young People’s Clinic. Adult Type 1 Diabetes, Complex Type 2, New Patient, Metabolic and Cystic Fibrosis Related Diabetes Clinics.
Associated clinics: Gestational and Diabetes in Pregnancy Clinic. JHH outpatients Clinic Level 2. High Risk Foot Clinic and Combined Diabetes/Foot Clinic. Level 1 RNC.
Newcastle
Empowerment Program for people with type 1 diabetes who want advanced skills for diabetes self-management. Insulin Pump Commencement, upgrades and downloads. Continuous Glucose Monitoring System (CGMS) set up and downloads. Medical clinics for Adult Type 1 Diabetes, Complex Type 2, New Patient Clinics (Tuesdays). Individual Diabetes Nurse Educator and Dietitian consultations for patients newly diagnosed with type 1 diabetes. Individual education for people commencing insulin therapy. Individual instruction for self-care activities (eg. SBGM). Individual education for people with existing type 1 or type 2 diabetes who are inappropriate for group education and/or have complex problems. Individual consultations for gestational diabetes with a nurse educator and a dietitian. Gestational Diabetes Mellitus (GDM) groups on Wednesday afternoons with a nurse educator and a dietitian. Pre-op reviews.
Toronto
Individual Diabetes Nurse Educator and Dietitian consultations for patients newly diagnosed with type 1 diabetes. Individual education for people commencing insulin therapy. Individual instruction for self-care activities (eg. SBGM). Individual education for people with existing type 1 or type 2 diabetes who are inappropriate for group education and/or have complex problems.
Raymond Terrace
Individual Diabetes Nurse Educator and Dietitian consultations for patients newly diagnosed with type 1 diabetes. Individual education for people commencing insulin therapy. Individual instruction for self-care activities (eg. SBGM). Individual education for people with existing type 1 or type 2 diabetes who are inappropriate for group education and/or have complex problems.
Wallsend Individual Diabetes Nurse Educator and Dietitian consultations for patients newly diagnosed with type 1 diabetes. Individual education for people commencing insulin therapy. Individual instruction for self-care activities (eg. SBGM). Individual education for people with existing type 1 or type 2 diabetes who are inappropriate for group education and/or have complex problems.
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Belmont
Adult diabetes medical clinic (Tuesdays) Dr Quach only. Individual Diabetes Nurse Educator and Dietitian consultations for patients newly diagnosed with type 1 diabetes. Individual education for people commencing insulin therapy. Individual instruction for self-care activities (eg. SBGM). Individual education for people with existing type 1 or type 2 diabetes who are inappropriate for group education and/or have complex problems. Review of inpatients requiring diabetes education, as required. Any requests need to be discussed with the Service Manager and inpatients seen will require a CHIME Service Request.
Maitland
Gestational and Diabetes in Pregnancy Clinic and group education program. Individual Diabetes Nurse Educator and Dietitian consultations for patients newly diagnosed with type 1 diabetes. Individual education for people commencing insulin therapy. Individual instruction for self-care activities (eg. SBGM). Individual education for people with existing type 1 or type 2 diabetes who are inappropriate for group education and/or have complex problems. Individual consultations for gestational diabetes with a nurse educator and a dietitian. Review of inpatients requiring diabetes education, as required. Any requests need to be discussed with the Service Manager and inpatients seen will require a CHIME Service Request.
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Minimum Standards of Care in GNS Diabetes Service
It is the expectation that all staff involved in the care of patients and their support persons will deliver high quality, best practice care that is patient centred. All staff will follow best practice principles which encompass (but are not limited to), privacy and dignity, clinical assessment and monitoring, communication and documentation, promoting self-management, clinical intervention and management, medication education and management, and preventing risk and promoting safety. Patient-centred care is an approach where health professionals and the patient and their family/support plan, implement and evaluate care provision, in partnership. This framework needs to be adopted as a collaborative approach between all health professionals involved.
Privacy and Dignity • All patients will be informed of their rights and responsibilities when accessing services. • All patients will be treated with respect and dignity. • All patients will be treated with confidentiality. • All patients’ religious and cultural needs will be respected and attended to where possible. • Requests by patients to have family/support involved in the delivery of care will be respected and accommodated where possible.
Clinical Assessment and Monitoring • Clinical assessments will be comprehensive and culturally appropriate. Clinical note templates are utilised to ensure assessments are standardised, objective and measurable, but may also have aspects tailored to the needs of the patient. • Prior to providing education and/or clinical care, the staff should consider the patients’: . Reason for referral to the Diabetes Service . Type of diabetes, time since diagnosis, current diabetes treatment, diabetes control, and other comorbidities and current medical conditions . Medical history . Degree of mobility . Cognitive function . Cultural or language factors . Own priorities and wishes . Social support This information is collected during contact with the administration staff and during initial and subsequent consultations and with clinical staff when initial assessment occurs. • A Better Health assessment will be conducted and recorded on patients, as appropriate.
Communication and Documentation • Staff are to wear the regulation identification and will introduce themselves to the patients and their carers/support. • Patient confidentiality will be maintained during communication with all health care workers. • Communication is to be accurate, timely and responsive to the needs of the patient. • The patient will be involved in goal setting and where relevant will be involved in the decision- making of intervention and therapies. This in imperative for self-management of diabetes. • Treating teams will communicate with each other all aspects of the patient’s diabetes management. • Patients will be asked if they identify as Aboriginal or Torres Strait Islander to ensure that cultural needs are discussed and addressed.
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• Interpreters, multicultural health and Aboriginal Liaison Officers will be appropriately involved to facilitate communication and care and treatment plans. • All health care records must include a unique identifier (MRN) for each patient along with surname, other names, date of birth and gender (the latter written in words not initials). • Documentation will be clear, concise, contemporaneous, progressive and accurate and will comply with current policies and guidelines. Outcomes of CHMRAT audits will be used to indicate deficits in documentation in CHIME that need to be ameliorated. • Documentation will reflect the patient’s needs, the diabetes education and care provided to the patient, and clinical decision making relating to changes in the care delivered. • Assessment, plans for care and patient outcomes will be documented factually, enabling clear communication between health care workers. • Breaches of policy or standards will be reported, utilising IIMS, the incident management system. All staff are required to complete IIMs Notifier Training as part of mandatory training. • Clinical incidents will also be documented appropriately in the patient’s clinical record. • Sharing clinical information with other services involved in a patient’s care should be discussed with the patient/carer on a case by case basis. Documentation of these discussions must be made in CHIME clinical notes as soon as possible after the event.
Promoting Self-management • Care will optimise the person’s diabetes control to prevent or delay diabetes-related complications. • Culturally appropriate education will be provided to the patient and their family/support. • An environment will be provided that encourages diabetes self-management to occur safely, and patients with complex/chronic comorbidities will have individualised plans. • A coordinated discharge process, including follow-up care and relevant resource provision, will be followed. • The transition of young people with diabetes form paediatric to adult diabetes services will be a well-coordinated process in consultation with the young person and their family.
Clinical Interventions and Management • Patient identification is verified prior to any intervention and consent is obtained prior to any intervention according to policy. • Interventions will be evidence-based and delivered by clinicians according to their level of competency and scope of practice. • The intervention, outcome and any further management is communicated and documented according to policy.
Medication Management • Medications will be provided, administered and documented according to legislative requirements and national and local guidelines. • Medications will be stored, handled and transported according to national and local guidelines and legislative requirements. • Effective communication and coordination between health care providers and the patient and their support will occur to provide safe and effective medicines administration and will include identifying self-management needs, goals and strategies to meet those goals.
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Preventing Risk and Promoting Safety • Hand washing and other infection control procedures will be followed strictly in circumstances where patient contact is required as part of the care provided. • Consultation areas and group rooms will be free from hazards and staff will minimise potential risks when patients are weighed or undertaking other activities.
Agreed Behaviours Supporting the Delivery of Quality and Safe Care The Diabetes Team has developed and regularly reviews a list of agreed acceptable and unacceptable behaviours within the GNS Diabetes Service, based on the HNELHD Core Values. This document can be accessed from the share drive under: :\Common\Administration GNC Diabetes\HR\Standards of Behaviour\2018-19 Diabetes CORE Standards of Behaviour
Self-Assessment Tool for Staff A self-assessment tool that staff can use to reflect on their compliance with the agreed minimum standards of care for GNS Diabetes patients can been found on the share drive under: :\Common\Administration GNC Diabetes\Staff Orientation\Self Assessment of Minimum Standards
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General Information about the Service
Meeitngs: Nursing Team Meetings: Are conducted 2nd monthly at NCHC on Monday afternoons. Diabetes Educator Support Intervention (DESI) will be conducted during this meeting for newer Nurses. The minute taking and chairing of the meeting is shared amongst the nurses. The meeting agendas and minutes are located on the share drive under :\Common\Meetings\GNS DIABETES MEETINGS-All\GNS Diab Nurses Meetings Inservices may be conducted during this meeting for Nurses, by Diabetes Team members or external providers.
Dietitian Team Meetings: Are conducted 2nd monthly at NCHC on Monday afternoons. Clinical Supervision and Journal Club Education are before the Dietitian meeting at 8:30am and 9.30am respectively. The meeting minute taking and chairing and conducting the supervision and education sessions are shared amongst the dietitians. A schedule for the meetings and the meeting agendas and minutes are located on the share drive under: :\Common\Meetings\GNS DIABETES MEETINGS-All\GNS Diab Dietitians Meetings Inservices may be conducted during this meeting for Dietitians.
Service Meetings: Staff Meeting is 2nd monthly prior to the Dietitian and Nurse meetings, commencing at 8.15am at NCHC. The minutes are taken by an Admin staff member and disseminated via email within one week and saved on the share drive.
Professional Presentations: Guest presenters from other services and pharmaceutical and equipment company reps presentations on an ad hoc basis, as required, at NCHC. Often these scheduled for meeting days to maximise staff attendance.
Leave Management: All leave request are managed via eLeave. • which is available through the applications portal or at http://hneleaveapplication.hneahs.nswhealth.net/Pages/default.aspx.
Sick leave: Contact the Service Manager either the day before or on the morning of the leave requested on 40164627 or Mob 0419 712 245. Sick leave needs to be documented in eLeave upon return to work. A medical certificate is required for sick leave longer than 2 days.
Annual leave: The Service Manager ensures there is adequate clinical and administrative cover when people take annual leave. The service closes for 2 weeks over the Christmas period and annual leave is required to be taken during this period unless negotiated with management.
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Time in lieu: All Time in Lieu (TIL) to be agreed by the Service Manager prior to accruing/taking same TIL is NOT to be accrued by staff working through meal breaks. TIL summary to Service Manager on a monthly basis. The minimum amount of TIL that can be accrued is 30 minutes. The maximum total amount of TIL that can be accrued is one shift of standard length for any employee. The accruing and taking of TIL is conditional on the prior mutual agreement of the staff member and manager. Normally TIL will be taken within the pay period in which it occurred, or if this is not possible, within three months. A TIL template can be found on the share drive under: :\Common\Administration GNC Diabetes\HR\Payslips and Leave StaffLink Forms and Proc
Conference Leave Conference leave is submitted via eLeave after discussion with the Service Manager. Requests need to include the type of leave, registration requirements, accommodation and flights, Conference leave must be approved by the Service Manager prior to submitting abstracts, registering or booking travel and accommodation. If accommodation and flights are approved, they need to be booked with the HNE Health approved provider, currently Hello World.
Car bookings: Fleet cars are managed via Smartpool. Book cars through Level 2 Diabetes Administration. Provide your current driver’s licence details to the Service Manager – a photocopy is kept on file. This needs to be updated when you renew your licence. Mileage and time in and out needs to be recorded on the sheet.
Parking: Free parking is located near National Park netball courts in Smith Street. It is a 10 minute walk to the building. There is also all day parking for $6 in the old RMS building car park. There is free parking in both of the Market town Shopping Centre carparks, but there is a 2 and 3 hour parking limit. If you overstay you are likely to be fined and you cannot move your car to the other carpark as number plates are logged. Paid 2 hour parking is available on Hunter Street. These parking areas are heavily monitored so be aware! Buses pass frequently and stop right out the front of the Community Health building in Hunter Street. This is a great option and there are a number of routes. There is a close tram stop and the Newcastle Interchange train station is within walking distance. When at the John Hunter Campus, free parking can be found on the main road or there is paid car parking in the carparks for $10 per day.
Whereabouts: All staff working offsite are to send an email to Service Manager when starting and finishing each day when working at outreach centres or offsite clinics. An in/out attendance board is updated each day by the Admin staff on Level 2 for staff working at NCHC.
Photo ID: You will be provided with a photo ID name tag which must be worn at chest height at all times while at work. The photographer visits sites on rotation, so you may be required to have your photo taken and badge processed at another site. The Service Manager needs to sign the request form.
Uniforms: A uniform is provided by HNE Health and is ordered using through the Total Apparel Management System. New employees can submit their uniform allocation online from the
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approved range for their position, once they have received a payroll number. New starters and replacements due to wear and tear will continue to be made from the remaining items in the current uniform range where style and sizing permits. Staff experiencing difficulties with uniforms should contact the HNELHD Uniform Coordinator on ext 53436 or [email protected]
Ordering supplies: Most stationery supplies required will be in stock onsite, so request what you need from the Admin staff. A hard copy diary may have to be ordered. To order all food or clinical supplies for sites other than Newcastle Community Health Centre send an email to Talia Kelly, Administrative Officer at: [email protected]
Access to computers and applications - Login and passwords: Your login for computers at any workstation is your employee payroll number which will be assigned to you on recruitment. You will be able to change the initial password assigned, but the new password must be of certain length, with alphanumeric characters, upper and lower case. This is the login you will use to access the Diabetes Service share drive, the HNE Health intranet, My Health Learning, StaffLink, e-Leave and emails. Access to the share drive is granted after Service Manager approval has been processed. You may need to map the share drive and printers from different PCs if changing workstations or sites. To access the diabetes share drive (GNC Diabetes share drive) you will have to map it to the computer if you are a first time user. On the computer desktop select “My Computer”, select “Map Network Drive”, When the “Add Network Place Wizard” pops up type in ”\\hneahs\shares\GNC Diabetes” into the folder box. Make sure the Reconnect at logon box is ticked. Select “Finish”. When you have finished using a computer, restart the computer so it remains on overnight for any upgrades. Do not shut it down or turn the power off. All guidelines and policy statements can be accessed on the intranet by clicking on the PPG directory link on the homepage or via http://intranet.hne.health.nsw.gov.au/ppg Health Pathways can also be accessed via this link on the intranet homepage. You should have a shortcut to the electronic version of Australian Dictionary of Clinical Abbreviations Acronyms & Symbols on your desk top. The link to this resource can be found on the PPG site. You will need access to CAP and CHIME to document clinical notes
Telephones: You need to add a 0 prefix to an external phone number, including the emergency number (i.e. 0-000). Note, if at John Hunter or Belmont Hospitals, the emergency number is 222. There are phones in clinic rooms and the shared office. Staff are not give patients their personal number. If a mobile phone is required to contact a patient or send a message, 040723263, the CNC mobile phone can be utilised.
Core Standards documents: The following documents are located on the share drive: Current Standards of Behaviour: Agreed acceptable and unacceptable behaviours within the GNS Diabetes Service AIDET: The 5 Essentials of Client Communication ISBAR communication tool.
Staff Roster and Service Calendar: You will be e-mailed when the monthly roster has been finalised and clinicians are then required to populate appointments in their CHIME Diary (see below). There may be situations where last minute changes are made to the roster due to appointment cancellations and varying waitlists. You will be notified if changes are made to your roster, if changes are made after being finalised. The master roster is located on the share drive under ROSTERS. This is a read only document and you are requested to close it once you have viewed it, as changes will not be able to be made by the Service Manager while the file is open.
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There is a tab on the roster spread sheet that has scheduled dates for meetings, other events and group education sessions.
Templates: The following templates are located on the Diabetes share drive or the HNE Health intranet: TIL form CHIME diary templates Education Assessment sheet template - There is a guide to completing this on the share drive Discharge letter template FTA/cancellation letter templates
Mandatory training: Mandatory training courses are predominantly completed online, but some are practical sessions. Courses are accessed or booked though My Health Learning on the HNE Health intranet site. On the homepage, find My Health Learning via the Site index. A weekly mandatory training report is run by the Service Manager who sends ab email to staff with outstanding training to complete. An annual Performance Development Review (PDR) will be scheduled by the Service Manager.
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Administrative and Clinical Procedures
CHIME Standards and Definitions The latest guideline can be accessed from the PPG site on the intranet: CHIME Standards and Definitions HNELHD Guideline 14_01. Populating appointments in CHIME: Once the staff roster is finalised, it is your responsibility to create blank appointment slots in CHIME so Admin staff can book patients for individual community based appointments. If there are days or times where you will not be seeing community patients requiring CHIME (e.g clinics at RNC, GDM groups at Wallsend or Belmont), please add a comment and put reserved time in both your diary and the centre diary. You will be advised on the booking template which will specify the number of appointments and duration of appointments to allocate in your CHIME diary. If you have any concerns with this, please speak with the Service Manager.
Individual appointments in CHIME: All individual appointments require patients to be given a Rights and Responsibilities brochure and given a Better Health Assessment (and recorded in the Assessments node in CHIME). Only give the Rights and Responsibilities brochure if this has not been given by someone else in the diabetes team. Only do a Better Health assessment if one has not been completed with the patient in the last 6 months (by any team in Community Health). Complaints should be addressed and managed in accordance with NSW Health Policy PD2006_073 Complaint Management. Process of occurring appointments in CHIME: . When you have entered into the appointment, ensure that you move across each of the 6 tabs (remember the Resource tab does not need to be completed) . Ensure that all appointment details are correct before occurring the appointment, as no changes can be made once occurred.
Number of appointments offered: The number of appointments required for a patient is determined individually. Generally, an initial and 1-2 follow up appointments with an educator and/or dietitian, is all that needs to be provided, as patients are discharged back to their GP for ongoing management. However, in some cases, more appointments/reviews are necessary.
Referred patients not able to be contacted: The administrative staff attempt, up to three times, to contact referred patients by phone. If not contactable, the referring GP is contacted to confirm correct patient contact details (if not, details updated in iPM) and up to a further three attempts to contact are made. If the patient is not contactable, a letter a sent to the patient advising them to contact the service. If they haven’t phoned within two weeks the administrative staff sends their GP a letter to notify the patient was not contactable. When a patient advises they are unable to commit to an appointment time, and subsequently fail to phone for an appointment within one month, a letter is sent to the referring GP.
Confirming patient ID: It is imperative that you ensure you have identified that you have the correct patient for both face to face and telephone contact. This involves confirming full name, date of birth and address. These identifiers may be verified by a photo ID such as a drivers licence or Centrelink/proof of age card. Medicare cards are not recommended as a verification tool, but a Medicare card may need to be scanned at their first appointment so Admin can enter the details into i.PMS. Patients who did not have Medicare Card details available at the time of booking are asked to bring it to their appointment.
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Process for “walk in” patients: Patients who do not have an appointment with the service, but who walk in, may require immediate clinical intervention. However, such self-referred patients may not have the required relevant documentation needed to inform correct clinical decision making. If the patient has a determined clinical need for a consultation, and there is a clinician available at that centre on the day, the patient may be offered an appointment, if they have a current written referral. Clinicians should use their clinical judgement about the need for a written referral. In this situation, try to contact the patient’s GP to confirm the level of urgency and obtain relevant clinical information. If the patient requires an urgent appointment for an issue or situation which requires only minimal assistance from a clinician, then a referral is not required, and they can be seen on the spot if a clinician is available, or an appointment can be arranged for the patient. . Blood glucose meter or insulin delivery device instruction . Faulty blood glucose meter or insulin delivery device . Problems with insulin pumps . Hypoglycaemia symptoms . Concern regarding BGL readings . Brief general diabetes or dietary information . Emergency supply of insulin, and other diabetes related products required . Confirmed diagnosis of pre-diabetes – these patients are referred to Connecting Care
Process for Home Visits: Ensure criteria for the home visit is met. These are prescribed in the local guideline and procedure: Home Visits by GNS Diabetes Service – GNS-CACS DIAB 19_044. Have the home visit approved by the Service Manager. Conduct all steps required to achieve informed consent, and follow the processes for patient identification, correct procedure and correct site process. Follow all processes to ensure staff safety, including mandatory checks on the home to be visited, manual handling and infection control. Access all equipment required for the visit and arrange transport. Conduct the visit, and report on any incidents as required.
Process for documenting in CHIME: No CHIME/CAP printouts are to be scanned into CHIME. All original documents scanned into CHIME must be kept for 3 months after scanning for QA and Records Management Act requirements. The majority of health information should be documented in the CHIME clinical Note area for continuity of care and legibility. Information scanned into the Attachments node is often missed by CHIME users, as it sits outside the clinical note area of CHIME.
Process for discharging patients: The patient can be considered to be appropriate to discharge if: . The patient has good diabetes control: general HbA1c target is < 53 mmol/mol (<7.0%)* OR . There has been an improvement in glycaemic control with evidence that the patient has reached maximum capacity for improvement, or is moving towards this and the patient has been assessed regarding diabetes management and appropriate changes have been recommended. * Note: HbA1c targets may need to be individualised. An HbA1c target >53 mmol/mol may be appropriate in people with type 2 diabetes who have a history of severe hypoglycaemia, a limited life expectancy, co-morbidities or who are elderly. Patients referred to and attending group education programs can be discharged after their final session. If a patient fails to attend 3 scheduled appointments they are discharged from the diabetes service.
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A discharge letter, generated from a template in CHIME, is sent to the referring doctor outlining education, management and medication changes, if relevant.
Responsibility for discharging patients and writing GP feedback letters: After you have seen the patient, a feedback letter should be provided to the GP, though this may not be required if the patient has multiple visits scheduled over a short time period. While the GP may not require a feedback letter each time you see their patient, another letter should be sent when you are discharging the patient from the service. The last person to see a patient is responsible for writing a letter to the GP and discharging the patient through CHIME. Even if another clinician has previously seen the patient multiple times before, you may use their notes as a summary and add your notes. It is still the final clinician’s responsibility for writing the discharge letter, and it should be sent within two weeks of the last appointment. GP letters need an indirect appointment created and are documented by a specific indirect template.
Diabetes Service Procedures at NCHC
Location: Newcastle Community Health Centre, 670 Hunter Street Phone - 40164666
Service Manager, CNCs and Program Implementation Officer Offices: These are located on Level 3, at the north end of the building.
Diabetes Shared Office Level 2 NCHC – Admin and Clinicians: . There is a shared office on Level 2. You need a swipe card to enter the clinical area through the glass doors located past the toilets. . The door to this room must always be closed, this is for personal safety and to prevent theft of items. . Walk all the way to the end and it is the last door on the right (has a sign that says Diabetes Staff Only). You need a swipe card to get into this office as well. It is recommended you have your own swipe card for the Newcastle site, as second monthly team meetings are located at this site. Swipe card access forms are accessed on the share drive under: :\Common\Administration GNC Diabetes\Staff Orientation . There are three computers used by Admin staff on the left as you walk into the room. The workstations facing Hunter Street are hot desks, and these computers are available for use by staff who are located there that day. Rooms on Level 2 are to be utilised first to minimise noise for Admin who are making phonecalls, before using the hot desks. . There are also spaces allocated for bags and resources for each staff member. . There is a Group Education Room next door that is sometimes used by Cardiopulmonary Rehab and the Falls Education Team. There is a kitchenette and fridge we can use to store our lunch and make coffee/tea, however, be mindful of groups that may run at any time. . There is a board indicating when individual staff are onsite and offsite, please keep this board up to date with your movements.
Diabetes Clinic Rooms: Our outpatient clinic rooms are listed on the whiteboard in the shared office. Write a room number next to your name to show where you will be located that day. The rooms are in the hallway on the other side of the building. When you exit the Diabetes Office, turn right and go down the next hallway to a door that will lead you into the corridor with the outpatient rooms. Rooms are numbered. There is another exit door all the way down that corridor to the left (is marked ‘EXIT’), so patients can be collected and exited through that area. We have a diabetes trolley with education material and medical equipment located in the store room off the corridor with the outpatient clinic rooms. You will need a swipe card to enter this room. It has a name ‘STORE ROOM’ on it, so it is easy to find.
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Pathology North is located in the same corridor as the shared office. The room next to it is the Diabetes clinic room, generally used by nursing staff for the Tuesday Diabetes Medical Clinic. This room has scales and a height measure and another diabetes trolley. This clinic room should not be used for individual consultations with patients.
Group Education Room: Room 2090 is used by our service for Group Education Sessions. Group participants will wait in the large waiting area near the Level 2 lifts. They will not have access to swipe cards, so there will be one card that the patients can use when they need to go to the toilet during the session. Ask our Admin staff to supply this card to you and then sign it out. There is a computer and projector located in this education room. Please check milk, coffee, tea supplies etc, and make sure they’re in date, and order more when running low. To order send an email to Admin staff. The trolley in the ‘EQUIPMENT ROOM’ has a number of food packets for label reading. All other resources will need to be printed before the group session and are not stored for long term use.
Amenities: Fridge space, urn and microwave in group room next to the Diabetes Office on Level 2. There is also a kitchenette and dining area on Level 3 with more fridge space, two microwaves, an urn and a water cooler. Advised to BYO cutlery and coffee cup. Toilets on Level 2 just near waiting area and on Level 3 opposite the three large lifts.
Security: All non-patient areas require swipe card access. Personal duress alarms are available from Level 2 reception and many consultation rooms have fixed duress alarms. The service is on a monthly roster to respond to alarms.
Emergencies: Fire and emergency evacuation and lockdown procedures should be followed as per the site guideline, with the designated assembly area for evacuation in the park next to the building in Hunter Street. Talia Kelly is our Level 2 Fire Warden.
Printing: All computers on Level 2 should be linked to the shared office printer “DIABMFD”. It does not print in colour. There are colour printer options on printers on Level 3 if required, but this function is to be used on if absolutely necessary, due to the cost of colour cartridges. There is also a fax/scanner/photocopier and a laminator in the office you can use.
Shredding: There is a large shredding bin located in the shared office. All documents with any patient details must be shredded.
Mail: Envelopes are kept in the shared office. There is a basket for all outgoing mail. Staff pigeonholes are to the left of the door when you first enter the office.
Procedure for Clinics/Groups: When you arrive for a clinic or group session, you must first email Simone to let her know you have arrived to start the day. Level 2 Reception is staffed by a community health receptionist (which on Tuesdays is usually a Diabetes Admin staff member) and a dental health receptionist. Introduce yourself to the community health receptionist and let her know your phone number or email so they can notify you when a patient arrives. If you have a clinic, the receptionist should already have a list of patients to see the diabetes team. If you have a group, there will not be a list of patients given to the receptionist, so you will have to let them know there is a group running and identify a way for reception to contact you when patients arrive. Always check the waiting room a few times in case patients do not present to reception.
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Medication Management: The management of insulin within a community setting has different requirements to those within the hospitals. We are required to maintain a record of stock in, out, expiry dates and disposal. Minimal amounts of different insulins are stored in a designated medication fridge on Level 2 NCHC. These are ordered and delivered from Belmont Hospital Pharmacy. Once unpacked, the foam boxes are to be left in the designated shelf area in the Pathology Specimen Room to be collected, with a large note advising pickup by Belmont Hospital Pharmacy. Expiry dates on insulin stock are checked monthly and out of date stock disposed, as per policy. The medication book (RED) will also need to be completed to indicate that stock has been removed ensure accurate auditing of stock movement and to ensure that stock supplies are audited and rotated to reduce the risk of stock becoming expired. Medications can only be dispensed to patients by a medical officer. This requires the completion of details in the medication book (located in the fridge) and the addition of a dispensing label (also in the fridge) to the patient’s device. Medications cannot be supplied to a patient by a registered nurse, CNC or credentialed diabetes educator, unless they have been dispensed, including affixing a patient label with patient, medication, dosing details on the medication. Labels will be kept in the fridge with the insulin supplies. Scripts are to be supplied to patients for initial and ongoing supply of insulin. Samples from pharmaceutical companies cannot be received and distributed by HNE staff.
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Diabetes Clinics at RNC Location: Royal Newcastle Centre, John Hunter Campus Phone (back office) - 49223215
Young People’s clinic (YPC) is held each Thursday afternoon and evening. See the procedures document on the share drive for this clinic. A dietitian and nursing staff participate in the Friday Diabetes Clinics at the RNC. The dietitian is available for walk-ins if the workload permits. . The dietitian has an independent list, but as a matter of practicality, patients often see more than one clinician on the same day. . The afternoon clinics on Fridays are smaller and the workload can be variable. There is a possibility of walk-in patients, but this is uncommon. The dietitian can see walk-ins if the workload permits. . Friday mornings is a large clinic with a high workload including multiple walk in patients as well as the booked list. These clinics are booked through i.PM under the various specific codes and documented under DMR and CAP. Clinicians attending these clinics need to be familiar with the operation of all of these systems. DNA rates are variable but tend not to be as high as those for our outreach centres. Currently these clinics often provide survival information for patients converted to insulin, newly diagnosed or needing urgent refresher information. In many cases patients are happy and do well with the level of information provided at the clinic and resist attending more indepth education. There is a lunchtime Friday journal club that all staff can attend. GNS Diabetes clinicians are able to present on occasions, on topics of their choosing.
Friday Clinic procedures: Preparation for the clinics by the Nurse Educator: . Check Insulin Fridge Temperature – Door code C23XY. - Document current temperature, HIGH & LOW. - Reset by holding HI/LO button until it beeps. - Complete form found on fridge shelf – If new month, spares in nurse pigeonhole. Initial and write current time. - If any delivered insulin, unpack as appropriate. . If any insulin levels are running low, advise the Service Manager, to arrange an order. . Check Resuscitation Trolley. - Test Defib as per instructions on the wall. - Check Oxygen, Suction and shelves as per checklist. - Sign book and replace any items needed from stores. . Trolley and Afinion HbA1c Machine. - Located in the YPC cupboard. If padlocked, Code #401. - Turn on Afinion machine and place strips and run sheet on top of trolley. - Place record books on desk and give out as patients need. - Run sheet on desk. - BGL machine onto desk with yellow kidney dish. Patient flow in Friday clinic: . Patients report to the front desk and are asked to take a seat. The admin staff at the front desk arrive the patient. The front desk deals with patients from all the clinics running on the floor. . There is another admin person associated with each specific clinic. On seeing that a patient has arrived this person retrieves the pre-printed record sheet containing the patient’s details and a bar code combined with another sheet containing patient labels and places these in an in tray. There is one set of documentation for each clinician the patient is booked to see.
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. The nurse designated to process the patients retrieves these sheets and weighs the patient, records their height if a new patient, and BGL, last meal eaten and other information such as needle length if on insulin therapy, then places the sheets in the appropriate clinician’s tray. Until this happens the clinician is not aware that the patient has arrived. This nurse also functions to ensure that patients flow through the clinic in as timely a manner as possible by monitoring clinicians’ workloads and directing patients who need to see multiple clinicians so that waiting times are minimised. This person also organises the admin staff to create blank documentation sheets for walk in patients and makes sure these know that they need to see the dietitian before leaving. If there are no available appointments, the dietitian booking needs to be done in the back office. . There is usually a second diabetes nurse educator who carries out insulin conversions, monitoring and technique education as requested by the medical staff. . Each clinician has a tray with a list of their booked patients. Walk-in patients are designated by placing a patient sticker on this list. Many doctors will ask before placing the sticker, but this does not always happen. . The clinician retrieves the blank patient sheet and calls in the patient. Notes are made on this sheet and it is deposited in the appropriate tray at the conclusion of the consultation for the admin staff to send for scanning. Any documentation that the clinician wants scanned with that record needs to have stickers placed on it and deposited in the same tray. Notes can be added to DMR electronically if paper based is not preferred by the clinician, and in CAP can also be used to document. . At the conclusion of the consultation if a follow up visit at the RNC is required the clinician fixes a patient sticker to an “Appointment Outcomes” form, indicates when the follow up appointment should be made and hands it to the patient to make the appointment at the front desk. Procedures for the Nurse Educator at the end of the clinics: . Pack up and clean up back observation area. . Restock trolley with Glucometers, Record books etc from store cupboard. . Refill BGL machines with lancets and cotton balls. . Fax any forms to Newcastle 401 64667 - Empowerment Course referrals. - Insulin Titration. . Send RUN SHEET in internal mail to Newcastle. . Any Afinion (HbA1c) forms. - Ensure pathology forms have Usual GP listed and Medicare number completed. (Use CAP to gain information) - Ensure signed by patient (Otherwise patient billed) - Send in internal mail (Pathology forms and run sheet) envelope to Judy Woods, Clinical Chemistry, JHH HAPS. Referral for Phone titration . Fax forms to Newcastle 401 64667 (as above). . Email Talia Kelly list of names and MRN to check all faxes received at end of clinic. . Original forms to go into DMR (Tray at admin).
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Other community Diabetes Service sites Wallsend Neal House, Wallsend Campus. Shields Lane Wallsend (off Nash Street Wallsend)
Parking: Free parking on grass/gravel area near Community Health (behind Diabetes Centre)
Phones: Educator’s Office Phone 49246032. Dietitian’s Office Phone 49246687/fax 49246033.
Security: Duress alarm on the Educator’s desk is checked weekly. Security contacted on mobile 0409923683 or through the switch x46499. Phones have the emergency number to call 0-000 on a sticker as a reminder. Fire and emergency evacuation procedures should be followed as per the site guideline, and move to the designated assembly. Email the Service Manager when you arrive and when you are leaving the site.
Accessing the site: Educator and Dietitian have keys and Security will also let you in. Educator will leave keys in top drawer, if on leave. The Group Room is also used as a waiting room for clients. Toilets located next door, off verandah.
Setting up: Photocopier located in kitchen. Fax located in Dietitian’s office. Printers not yet networked, attached to computer in Educator’s office. Shredder in Educator’s office. The kitchen is equipped with a fridge, jug, and microwave. Tea, coffee, milk provided. Scales in Group Room.
Mail incoming and outgoing: Post and collect mail at Booth building in the office located on the right hand side of the main entrance on Longworth Avenue. There is also access via the back entrance using the swipe card in the Educator’s desk top drawer. A daily mailing statement located in the bottom drawer of the Educator’s desk must be completed for all outgoing mail. Stores: Blood meters, strips, pens, needles etc are kept in the cupboards in the Educator’s office. Patient handouts are stored in the Group Room. NDSS forms, assessment sheets etc are stored in the bottom drawer in the Educator’s office. Old files are kept in the compactus in kitchen. Supplies, including milk, tea and coffee, need to be ordered through GNS Diabetes Admin at NCHC.
At the end of the day: Lock the door at end of the day. Make sure fans, heaters and air conditioner are all off.
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Toronto Community Health Centre. 6 James St Toronto 2283.
Parking: Free parking in car park.
Phones: Educator’s Office Phone 49358167. Toronto fax number: 49 358 163. Fax machine is at the front admin desk.
Accessing the site: The office is down the corridor next to the lift, you have to use the security code to enter. Everything, except blood monitor, is in this room for initial patient consultations.
Security access: To enter all corridors press the month & year date then OK.
Shredder: All patient related sheets/labels/path results are to be placed in the large locked bin in the room where the compactus is, all staff use this one.
Phone diversion: Divert at the end of the day. Instructions are on laminated card behind phone. Divert phone to admin desk here and not NCHC Directions are as follows: *21 *58102 and to cancel diversion: #21#
Photocopier: Use paper in machine
Daily duties: . In the main foyer near photocopier on the table is a staff arrival book, all staff must sign in and then when leaving sign out with the time. . Turn computer on and check CHIME daily list and print off, the admin staff like a list at the front desk so this can be either the printed CHIME list or handwritten . Take phone diversion off - #21# . Complete CHIME entries for patients’ appointments and clinical notes. . Lock your bag in the grey cupboard in the DE’s office. Key is found on the key ring kept in the top drawer of desk. Always leave keys there when you finish work . At the completion of your shift turn computer off and put in the restart position and leave at the CTRL-ALT-DEL screen . Complete patient’s CHIME notes and make sure you have put their next appointment into CHIME under the correct person and centre . Enter statistics on stat sheet found on document holder below computer screen . Check for messages - Message book at front desk where admin staff are, they will take patients name and contact number
Tea breaks: Staff tea room is upstairs and you can put your lunch up there in the fridge. Tea and coffee & milk supplied. There is a staff toilet up there or one in our corridor or down near group room.
Security: Lock your handbag in cupboard in DE’s office with the key with ‘my office’, carry this with you and leave in the top drawer at the end of the day or when your relief is finished. Dietitian uses the keys on days DE is not there.
The other keys (60179) unlock the tea/ coffee supplies that are found in the left hand side cupboard (next to Fridge) in the group room. No need to lock the right hand side cupboard in group room as this is used by another staff member. Please remember to always lock the left hand side cupboard after the group has finished Keys with red sticker also opens small filing drawer in the group room. (Always keep these locked) Blood glucose meters:
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Use any of the meters on DE’s desk. Performa™ or Xceed™, strips in locked DE’s cupboard.
Upgrade meters: . Roche please fill in registration form and fax to company, these are found in green folder. . Abbott please have patient to fill in warranty card and put DE sticker on, folder on small filing cupboard or take into NCHC.
Arrival of patients: At appointment times go around to the waiting room to see if they have arrived, sometimes admin staff will phone and let you know the patient has arrived, but if they are busy they may not.
Dietitian appointments: Dietitians add their own CHIME by arriving patients and add their next appointments into CHIME
Mail: All mail can be left at main front desk behind the admin staff or if internal mail put in internal mail tray at front desk or if you are going into NCHC take with you.
Diabetes Service mail box: Large timber pigeon holes has ‘Diabetes Education’, found above the external mail trays, check this each day for patient’s results and letters that then can be filed.
Message book: Admin staff will take messages and write in message book which is kept at the main desk, you need to check this a few times a day and then deal with messages as they come in.
Insulin: No insulin is kept at Toronto Polyclinic. Please ensure that the patient brings their own insulin by phoning to advise this prior to appointment. Pen needles found in the clean utility room same corridor as DE’s office. In the 2 bottom cupboards closest to the window you will find supplies. Insulin Action sheets found on top of the 2 drawer filing cabinet in DE’s office.
Stationery and equipment: Drawers under desk First drawer pens, etc Second drawer: envelopes, record books Third drawer: phone books
Small filing cupboard Assessment sheets for initial visit under initial assessment Healthy eating guides Food record sheets DA fact sheets
Filing system on grey locked cupboard Appointment page for people attending Type 2 ‘Taking Charge’ program Homework sheet to be issued at initial visit if attending above program Facts and Furphies alcohol information History sheets
Filing system on book shelf NDSS application forms and address sheet Patient record cards and blue folders What is Diabetes Pre Diabetes fact sheets Sit chair exercise sheet
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Grey cupboard Loan meters Blood strips Finger prickers and lancets Spare record books and stationary stuff Laptop: dietitian uses this, please make sure this is locked away at the end of the day.
On shelf: Blue folder CHIME information White folder Log for supply of insulin by CDE-RN
On desk: Green folder Patient referrals and any private pathology results - (photocopy only with the original sent to NCHC for scanning, don’t forget to put CHIME number or MRN on each patient sheet) Roche forms when upgrading meters. Stats sheet.
White folder Abbott upgrade information and DE stickers if you give out meters Red folder Patient Management cards Other folder Insulin information - other information can be found in drawers of 4 drawer filing cabinet
Maitland The Maitland Hospital. 560 High Street Maitland, 2320. In the Health Services Building (to the left of the ED entry/ambulance bays).
Parking: Paid parking across the road from Hospital, behind the Family Hotel. Free off street parking on the New England Highway outside the Hotel Mercure/Monte Pio Maitland, or on outer edge of sporting field behind hospital campus.
Phone: 49392263 DNE room: 49392263 (ext 55263) Dietitian room: 49 392572 (ext 52572)
Administration: Kathryn (Kathy) Clarke is the front desk Admin officer. Workings hours 9.30am - 2.30pm Amenities: Fridge space and hot water available in main lunch room Advised to BYO cutlery Toilets opposite admin office
Dietitians Office (swipe access and keys required): Office keys found in Diabetes pigeon hole in admin office (ENSURE THESE ARE RETURNED AT THE END OF THE DAY) First door on the left of the corridor, to the right of the waiting room is Dietitian room and second door is DNE room, adjacent. Swipe access required to enter corridor and administration office Hypo kit kept on desk in both offices – please audit hypo kit 6 monthly and sign off
Swipe cards:
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Kathy Clarke (admin) keeps a spare swipe card in her office that may be borrowed if you work at Maitland infrequently To obtain your own swipe card for Maitland, contact Gail Gifford (Healthshare) on ext.52737 (located on Level 1 around from Rehab Unit)
Group education room: Shared with Cardiac Rehab (R.L. Williams Hall) - opposite dietitians office Weigh scale, portable projector screen, etc. are located in this room Small office at rear of education room contains filing cabinet filled with group education materials/supplies, and tables to set up for Group Education sessions Fridge and hot water available for lunch
Printing/Scanning/Faxing/Mail: MDHHSUCOL-MFD is the main printer which is located inside the admin office Use same device for scanning – select one-touch option “Diabetes” to send to shared drive Fax from old multi-function device in admin office (labelled as fax machine) Mail is sent from admin office. Need to complete a mailing statement form – copies kept in pigeon hole – the place bundled mail in “outgoing” tray near window
Appointments: Patients wait in the common waiting area until collected by the dietitian. No admin reminders. Weight scale in Dietitian room, height measure on wall in corridor outside office Dietetic educational resources available in filing cabinet in each office.
Raymond Terrace Community Health Centre. 4 Jacaranda Avenue, Raymond Terrace, 2324. (previously the site of the old public swimming pool).
Phone: 49830800 Fax: 49830909 Staff are not to park in the centre car park – park in surrounding streets. Front door unlocks at 8am (so no point turning up early!). Sign in at the front reception desk and obtain a swipe card. You MUST return this at the end of the day Room Booking are usually done in advance via iScheduler, unless it is an additional clinic – check with diabetes admin. Our allocated room is usually GO38 or clinic room 17. It is located on the ground floor – go through the doors at the right of reception to the end of the corridor it is the last room on the right hand side.
Setting up: Printing can be sent to the printer at reception. Printer name is \\hneprinters01\ RayRecep01 There are some dietitian and nurse resources in the desk drawers in the consult room, and also in the Storeroom located in the same corridor as the consult room. There are 3 black boxes located in the storeroom with our name on them – you will find necessary resources including food models in there. Dietitian printed resources are best to be brought with you. Referrals are in Grey File case with basic documents requirements such as NDSS, Food Diary, What is Diabetes? etc. Other resources are located in folders in Cupboard Glucometers/test strips/control solutions and insulin pen devices are located on the top shelf in cupboard
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Insulin demonstration devices and needles are located on second shelf with Glucometer/ BP machine and Sphyg. There is a lunch room upstairs – turn right at the top of the stair and then swipe through the doors at the right of dental reception and follow the corridor to the end room Tea and coffee are available in the lunch room as well as the Beverage Bay located on the ground floor behind reception. Large range of shops available to purchase lunch if required. Food court in Big W complex also.
At the end of the day: Leave your light on and door open to indicate that the room has been used and needs cleaning.
Belmont Belmont Hospital - 16 Croudace Bay Road, Belmont 2280. Share an office spare with Belmont Hospital dietitians. This is found in the Allied Health Senior’s office area, behind the allied health office. Entry is behind the kiosk.
Parking: Paid parking $4 for the whole day - drive through boom gates, then turn left (disabled parking and night shift parking if you turn right) - or free street parking past the hospital grounds - along Green Point Drive in residential area. Please take notice of driveways, no parking areas, and bin days.
Procedures: To access the shared office space you need a FOB. If you do not have a FOB ask security to let you in. The Diabetes Dietitian computer is on right hand side, closes to the door (same side as Belmont Hospital Dietitians). The Educator computer is on the left hand side. If you will be working at Belmont frequently, then it is advised to apply for a FOB. Complete this form, and hand to Ljiljana Ianosevici (Executive Assistant) in the Administration Building. Otherwise, you will need to rely on other staff to let you in and out of office. http://intranet.hne.health.nsw.gov.au/__data/assets/pdf_file/0007/63466/Belmont_Fob_acc ess_security_02_39_013.pdf
There is a switch for airconditioning for the whole office area in the middle of the corridor. The entry door near the toilets do not close every time. Please make sure it latches to help keep valuable safe. Sign the “Sign In sheet”, kept at Switchboard, when you arrive to Belmont Hospital, and sign out when you are leaving for the day (in case of Emergency we need to know who is here) Introduce yourself (including name, department, discipline) to the Switchboard Operator, Admissions Desk (near waiting area A), and the Outpatients Team Leader (in waiting area B) Provide Patient List to the Switchboard Operator at the start of the day, with the following information: . Patient names and times . Waiting room they need to go to (i.e. Area B, Area A, Group room) . Your name and discipline (i.e. educator, dietitian) . Your mobile number, in case we need to call you (we will not give your number out) . This will be destroyed at the end of the clinic . The room you will be working from that day (check with the Outpatients Team Leader that morning) Ask Security to unlock the clinic room once the above steps are completed, if it is locked
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Note that the FOBs are provided to individuals on application, with no ‘spares’ available and are not transferable to other staff. Remember to check for clients waiting for you – no one will inform you that they have arrived and re-check waiting areas before you start your group in case any clients have gone to the wrong area. Outpatient clinic room procedure . Room 11 allocated for Mondays, and Tuesdays after groups. This is located down the hall from the Cafeteria, next to staff health nurse Jane Broadbent. We can request rooms on an adhoc basis to run extra clinics as required. . We have a diabetes trolley and set of scales in room 11. (However, the scales have recently disappeared.) . Thursdays we need to use the GP Access Room 3, rather than room 11. . It is recommended to check with the Team Leader (usually Jacqui Cafagna) at the start of the day as to which room to use . We have 2 bariatric chairs kept in GP Access Room 3 (light blue and purple) . Duress alarms in the walls of all clinic rooms in outpatient department, but not in GP access rooms . Height scale on wall outside outpatient department office Group education room procedure . Multipurpose room in the Administration Building. This room has exercise equipment in it. After signing in at Switch, turn right, follow on past the main entrance, walk into courtyard, and into next building. The room will be to your right. . Room bookings are made by Talia in iScheduler. Check piece of paper on front of door to make sure we have that room booked. Sometimes we have to use the small meeting room in that same building. . Fridge and hot water available. . Tall cupboard with sliding doors inside group room have food packets for label reading . There is a big white cupboard outside the group room (opposite toilets) that has other diabetes equipment for the groups. You will need to find Ljiljana Ianosevici and ask for the key (it will be the master key) to open these doors. . There is a blue basket with more food models to use. . Please check milk, biscuit, coffee, tea supplies etc, and make sure they’re in date, and order more when running low . There is a photo copies in the executive corridor (one of the rooms on your left). The printer code is 566216. You must replace any paper you use. Remember to log out of our printer code when you finish. . There is no computer to use, but you can take our laptop up to the group room as it connects to the intranet via wifi
Page Jacquie Cafagna if there are problems: Dial 13955 Press page number “3754” Enter your extension number Hang up Or call Jacquie on: 0429683045
Amenities: Fridge space in corridor outside our office Kettle and sometimes milk in corridor outside our office, otherwise hot water, milk, tea, coffee kept on staff kitchenette on medical ward ground floor Advised to BYO cutlery Toilets opposite entry into office, near the kiosk Staff Cafeteria:
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In the basement. Take the stairs near the lift. Go down one level. Turn right, then right again, and then first left.
Hypo kit: There are resus trolleys kept outside the group room and outside the outpatient department office. These are latched with a security device, and are audited every month or every time a drawer is opened (as the latch snaps). If you have to access a hypo kit and the latch is opened, you must inform the Team Leader, replace the items and have the trolley re- audited and re-latched. There are also Neo-H glucometers on our clinic trolley and in our office above our desks. Spare Lucozade and biscuits kept in the filing cabinets outside the Diabetes Office.
Phones: There is a phone on the Diabetes Educators desk that we can use. It is rarely manned, so voicemail services have been turned off. Otherwise, the phone will continue to beep for days/weeks until we check the voicemail, disrupting the hospital dietitians.
Checking office phone for messages: Press voicemail automatic dial button on the phone. Enter extension number 32258. Then type in security code 1954. Follow prompts to listen, save and delete messages.
Printing: Printer on dietitian desk is old, not very good, always low on ink. Link all computers to printer in the outpatient department office “BDOUTPAT02” There is also a fax/photo copies in this room you can use
Mail: Letters kept in second draw at dietitian desk. Otherwise, check the filing cabinets in the corridor as there are boxes of envelopes kept there too. Complete the Mailing Statement, kept in orientation folder on shared drive. Wrap this around all envelopes with a rubber band (kept in Educator’s drawer) and hand to switch at end of day. Internal mail can be left at switch at end of day too. Incoming mail will be kept in the diabetes pigeon hole behind switch. Bulky items can often be delivered to all sorts of places inside the hospital, so try not to have items posted from Reps. You must use the big blue security bags to send confidential patient information across sites. The key to open the padlock is left in the Educators top drawer.
Shredding: There is a cardboard box under the dietitian desk for shredding. Once this is full, please take it to admin desk (Chris) in the allied health office, and transfer it into the shredding bin (small plastic white bin).
Supplies: We have 2 filing cabinets in the corridor. One is a large three drawer filing cabinet, and another smaller 4 drawer cabinet. Our laptop is also kept in one of these drawers.
Procedure for Clinics/Groups: When you arrive for a clinic or group session you must first present to Switch, introduce yourself and sign in. The service will be allocated rooms on Mondays, alternate Tuesday afternoons (2 rooms) and all day Thursday. We can request rooms to run ad hoc extra clinics as required. Room 11 has been allocated for use when there is a clinic.
Provide a clinic/group patient list to the Switch operator (usually Belinda Penfold), include: . Waiting area the patients need to go to (Area A, Area B or Group Room)
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. Your name and discipline (nursing or dietitian) . Your mobile phone number . What room you will be working from (check with the Outpatients Team Leader) If your clinic room is locked ask Security to unlock it for you Remember to check for clients waiting for you – no-one will inform you they have arrived. Re-check waiting areas before you start your group just in case any clients have gone to the wrong area. See the attached document in this folder titled “Belmont Hospital procedures for GNS diabetes staff - clinic and group sessions” Remember to sign out when you are leaving for the day
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General Checklist Diabetes Service (CHIME) Prior to seeing client Service request has same start date as date of referral (include time if known e.g. fax) Service request to be accepted to org unit (waiting list) Service request allocated to clinician All alerts read Complete Home/Facility Risk Assessment template if seeing client outside CHC
Initial visit (These tasks do not necessarily need to be done in this order)
Ask if any of their contact details have changed - may need to add mobile phone number if not documented. Confirm if client identifies of Aboriginal or Torres Strait Islander. If any details need to be changed/added, please inform admin so this can be changed in i.PM. Ask if the patient has an email address if this is not currently in the contact details. Admin staff will add this to i.PM. Ensure patient has been provided with and that this is recorded in CHIME: . Copy of their Rights and Responsibilities . Copy of their Information on Privacy leaflet Note: This can now be done in the activity tab Ask patient if they have any allergies and reaction. For each allergy must have a separate alert made in CHIME. (refer to definitions outlined in ‘Alerts in CHIME – Guideline’) Record in CHIME Interpreter Check list if applicable and complete template A and B if necessary Reflect client’s carer into carer’s tab Ensure patient has referral from the doctor scanned into the attachment node. If patient brings other information write MRN on all pages and forward to Newcastle for Admin staff to scan into CHIME file Undertake initial visit as per education protocol, commence Complete initial visit assessment/ education form and Better Health Check and submit if possible as per protocol. This may include providing patient handouts, sending GP letter and completing appropriate referrals. Make appropriate follow - up appointment for patient and document in chime Move patient from intake through to assessment and treatment phase) - All direct and indirect time linked to an occurred diary appointment Work across CHIME tabs (eg staff attended, patient attended, activities etc) On a separate appointment complete and send doctor’s letter re patient’s attendance at initial visit, this is an indirect contact and patient is not required Ensure appointment has been ’occurred’ Complete and store patient’s record card Complete nursing/dietitian stats
Patients who Fail To Attend (FTA) or cancel and do not rebook
Accept service request Send FTA letter to patient from Individual / Reports tab:
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Template discharge letter for patients who FTA (to GP/referrer) – insert as clinical note “Your patient failed to attend their last appointment with the Diabetes Service. At this time they have not contacted our service to reschedule another appointment. At this time their file has been discharged. Please feel free to re-refer your patient in the future should the need arise.” Ensure appointment status states CANCELLED and the reason on the first chime tab, in the patient tab the reason for cancellation must be the same as on the first tab Copy appointment and change - Mode to “other”, ‘Indirect”, patient not required to attend, add GP, add Activity – Generic discharge to external individual Write up clinical note for GP letter advising of failure to attend. Save appointment Print report from Service provider tab – Generic feedback letter – send letter to GP Occur the appointment Close patients service request (this will stop the clock) NOTE: File can be re-opened if patient phones and rebooks once they receive the FTA letter
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DIABETES SERVICE STEPS FOR CHIME WORK FOR GROUPS
1. OVERVIEW You will need an appointment for:
Patients that have attended the group Patients that called beforehand to cancel Patients that called beforehand to rebook Patients that did not arrive Patient letters and GP letters The easiest way to do this is to copy and paste the original appointment, and stagger the time of the group to keep track of which group is which until it’s time to occur the appointments. Do this on the day of the appointment. It will look similar to this…
2. PATIENTS WHO HAVE ATTENDED SESSION 1
2.1 Open the appointment. Make sure the date, time, length of group is correct, as well as the focus, mode etc. Ensure all clinicians are added, including the Position ID for that centre. Note that the location for the Belmont group is different to the face to face appointments at Belmont. This is so that the generated appointment letter has the correct location written on there (e.g. Administration Building, rather than Waiting Area B)
2.2 Make a record somewhere of which patients attended, cancelled, rebooked and FTA, including their CHIME ID’s/MRN’s. This is important, because once the appointments are copied you will lose the cancelled reason in the ‘Individual Clients’ tab
2.3 Delete all patients from the ‘Individual Clients’
2.4 Click on ‘Group Clients’, then click on the ‘Service Request’ section and pick the correct date and location for the group. Admin will create these group labels at the start of the year. ‘Anonymous Attendees’ is always ‘1’
2.5 Hit ‘Open’ in the ‘Open Client’ section. This will open the group label.
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2.6 Change the Phase to Assessment and Treatment, you would normally for individual patients
2.7 Click on the ‘Members’ tab. This is where you will need to add all of the patients that have attended the group (not the patients that cancelled/FTA). Sometimes patients have already been added here for you – so if any of these previously added patients have cancelled/FTA you will need to delete them (see section 2.8)
2.7.a To add the patients, click on the square on the top right hand side of this page
2.7.b Then hit ‘Client’
2.7.c This is where you will add each patient individually. Click the green search button, and then add the patient’s detail. You must also choose the service request and start date (the yellow sections). You don’t need to select an end date for patients that have arrived
2.7.d If you are adding the patient into the group on the day of the appointment, you must back date to the day before e.g. if the group is 7th September, then you need to set the ‘Start Date’ as 6th September or earlier
2.7.e Once those three yellow sections are completed, just hit OK and the patient will now appear in the group label
2.7.f Repeat these steps for all patients that have attended, then close the page using the ‘x’ button
2.7.g Now hit the ‘Refresh’ button and all the patients you’ve just added will populate within the appointment
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2.8 For patients that have already been added into this group label before the day of the group, but have cancelled beforehand, or not arrived, then we need to end date them from the group label. To do this, go back into the ‘Members’ tab, highlight the patient, and then hit the ‘Edit’ button. Go to the ‘End Date’ section, and change the date to the day before the group (not the day of). If you end date for the day of the group, then the notes from the group will appear in the patient’s file, even though they were not present in the occurred appointment. Hit ‘OK’, close the group label, and hit the ‘refresh’ button again
2.9 Go to ‘Activities’ tab and add the correct activities. Usually one nursing and one dietitian activity. Make sure they are both ticked.
2.10 Add clinical notes for the appointment. Remember that these need to be generic notes, without any individual patient information, as these notes will appear in every patient’s file that is included in the ‘Group Clients’ tab. See 8.1 and 8.2 for clinical note templates
2.11 Change the appointment to occurred and hit save. This appointment is now complete
2.12 Go into each individual patient that has attended Session 1, and change their phase from Intake to Assessment and then to Treatment. Make sure the date and time reflect the start of the group.
2.13 At the completion of Session 1, you will need to inform the patients of the date/time/location for Session 2. You will then need to add the patients that plan to attend Session 2 into both the ‘Individual Client’ tab (so admin can send reminder text messages) and into the group label within the ‘Group Client’ tab (follow the same instructions as 2.7, except you don’t need to go in and backdate, as the current date is still before the date of Session 2) 3. PATIENTS WHO HAVE ATTENDED SESSION 2 3.1 Open the appointment. Make sure the date, time, length of group is correct, as well as the focus, mode etc
3.2 Make a record of which patients attended, cancelled, rebooked and FTA, including their CHIME ID’s/MRN’s somewhere. This is important, because once the appointments are copied you will lose the cancelled reason in the individual clients tab
3.3 Delete all patients from the ‘Individual Clients’ 3.4 Click on ‘Group Clients’, then click on the ‘Service Request’ section and pick the correct date and location for the group. Admin will create these group labels at the start of the year. ‘Anonymous Attendees’ is always ‘1’
3.5 Hit ‘Open’ in the ‘Open Client’ section. This will open the group label
3.6 Click on the ‘Members’ tab. Hopefully all of the patients that are attending session 2 have already been added after session 1. If there are patients missing, please add them and backdate to before the day of session 2. If there are patients that have cancelled/FTA then you will need to delete them and backdate to before the day of session 2. See 2.7 and 2.8 for these steps
3.7 Go to ‘Activities’ tab and add the correct activities. Usually one nursing and one dietitian activity. Make sure they are both ticked
3.8 Add clinical notes for the appointment. Remember that these need to be generic notes, without any individual patient information, as these notes will appear in every patient’s file that is included in the ‘Group Clients’ tab. See 8.1 and 8.2 for clinical note templates
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3.9 Change the appointment to occurred and hit save. This appointment is now complete
3.10 Go back to the ‘Group Client’ tab, open the group label, click on ‘Discharge’, then ‘Phase’, and then choose the ‘Change Reason’ as ‘Service Completed’
3.11 You now need to write GP discharge letters for the patients that have completed Session 1 and 2 and then change the phase to discharged for each patient. See section 7 and 8
4. PATIENTS WHO HAVE CANCELLED AND NOT REBOOKED 4.1 Open the appointment. Make sure the date, time (change back to the original time), length of group is correct, as well as the focus, mode etc. This should be the same as the group appointment that went ahead
4.2 Delete the group label from the ‘Group Clients’ tab
4.3 Click on the ‘Individual Clients’ tab and add the patients that have cancelled beforehand and not rebooked to a future date
4.4 Make sure there are no activities in the ‘Activities’ tab
4.5 Add a clinical note explaining that the patient cancelled the appointment and did not rebook
4.6 Cancel the appointment and choose reason ‘Cancelled at Client’s Request’. Hit save. This appointment is now complete. You will need to write a GP discharge letter for these patients and close their service request. See section 7 and 8.
5. PATIENTS WHO HAVE CANCELLED AND REBOOKED
5.1 Open the appointment. Make sure the date, time (change back to the original time), length of group is correct, as well as the focus, mode etc. This should be the same as the group appointment that went ahead
5.2 Delete the group label from the ‘Group Clients’ tab
5.3 Click on the ‘Individual Clients’ tab and add the patients that have cancelled beforehand and rebooked to a future date 5.5 Make sure there are no activities in the ‘Activities’ tab
5.6 Add a clinical note explaining patient cancelled the appointment and rebooked to a later date
5.7 Cancel the appointment and choose reason ‘Rescheduled at Client’s Request’. Hit save. This appointment is now complete
6. PATIENTS WHO HAVE NOT ARRIVED
6.1 Open the appointment. Make sure the date, time (change back to the original time), length of group is correct, as well as the focus, mode etc. This should be the same as the group appointment that went ahead
6.2 Delete the group label from the ‘Group Clients’ tab
6.3 Click on the ‘Individual Clients’ tab and add the patients that have not arrived
6.4 Make sure there are no activities in the ‘Activities’ tab
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6.5 Add a clinical note explaining the patient did not arrive
6.6 Cancel the appointment and choose reason ‘Non-Arrival. Hit save. This appointment is now complete
6.7 You should call the patient to follow up the non-arrival, as per our usual protocol. You will then need to either rebook to the next group, or 1:1s, or discharge, as per patient. If you are unable to speak with the patient over the phone, then you need to send a FTA letter to them. See point 6.8 and 6.9
6.8 You can generate a FTA letter to this patient from this cancelled FTA appointment. This process is the same as generating a FTA letter in a face to face appointment. Open the appointment, make sure all patients are highlighted yellow in the ‘Individual Clients’ tab. Click on the ‘Reports’ button and then run the report number ‘478’. You can then print these letters, but make sure that there is a separate piece of paper for each patient i.e. do not print double sided if the letter is only 1 page long (this usually won’t happen for FTA letters)
6.9 You will then need to send a FTA letter to the GP, and then close the service request. See section 7 and 8. 7. DISCHARGE LETTERS
7.1 You need to write discharge letters for all patients that have completed session 1 and session 2, for those patients that have not arrived, and for those patients that have cancelled and not rebooked
7.2 Create an appointment. The date, time and length does not need to be at the same time as the group, but it should reflect the time that you’re writing the letters. The ‘Focus’ is ‘Indirect’, the ‘Mode’ is ‘No Client Contact – Case Planning and Review’
7.3 Add your name and the position ID into the ‘Service Providers’ tab, and add all of the patients into the ‘Individual Clients’ tab. The ‘Group Clients’ tab should be empty. And the ‘Activity’ is ‘Generic Discharge Report to Referrer’. You do not need to create separate appointments for each patient. If you choose to use the ‘Generic Discharge Report to External Individual’ activity instead, you will need to add each individual GP in the ‘Add Participants’ section of each patient. You must cross check this GP with the name of the GP on the referral document to make sure it is correct.
7.4 Add the body of the letter into the ‘Clinical Notes’ tab. Please see the Appendix for letter templates
7.5 Ensure all patients are highlighted in yellow before you print the letter via ‘Reports’ tab. If the letter is only 1 page long, do not print double sided. Once you have printed the discharge letters, you can then occur the appointment, and then go into each individual patient’s files to change the phase from Treatment to Closed. Make sure you use the correct reason for closing the service request.
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8. CLINICAL NOTE AND LETTER TEMPLATES
8.1 Example of Clinical Note template for Session 1
Patient attended Type 2 Diabetes group education, Session 1
Diabetes nurse topics covered today:
Dietitian topics covered today:
Main nutrients and food groups, including food group requirements and energy reduction for weight loss (including alcohol)
Carbohydrate counting, dietary fats and blood lipids, salt use
Meal and snack ideas discussed in detail
Handouts provided: Carbohydrate exchange sheets, proteins, fats and free foods “The Glycaemic Index” by Baker IDI "Making Healthy Meals" by Baker IDI Meals containing three CHO exchanges handout Dietary fats and blood lipids handout
8.2 Example of Clinical Note template for Session 2
Patient attended Type 2 Diabetes group education, Session 1
Diabetes nurse topics covered today:
Dietitian topics covered today: CHO counting activity for various meals Label reading for total fat, saturated fat, sodium and CHO Counting CHO in recipes Modifying recipes for fat and sugar Eating out and takeaway advice Handouts provided: Label reading. Recipe book “Healthy Hints for Modifying Recipes” by Diabetes Australia “Eating out & Takeaways” by Baker IDI
8.3 Example of GP Letter template for patients that have completed both Session 1 and Session 2
Thank you for referring this patient for diabetes education.
Your patient has now completed the Type 2 Diabetes Self -Management group education program.
Topics discussed during the program include:
What is Diabetes? Risk factors for developing diabetes
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Factors affecting blood glucose levels How glucose works and role of insulin Exercise / getting started Monitoring diabetes short and long term Carbohydrate counting/ healthy eating/fats Food label reading/recipe modification/eating out Medications/hypoglycaemia Staying well/avoiding complications GP management plan, Enhanced Primary Care and Annual cycle of care Follow up and support organisations Your patient has been advised that regular medical review, HbA1c, fasting lipids, Micro albumin, retinal and podiatric assessment are all essential components of diabetes management.
At this stage no further appointments have been made with Hunter New England Diabetes Services.
Your patient can re-attend any time in the future should further education be required.
Regards,
8.4 Example of GP Letter template for patients that have attended Session 1 but did not complete Session 2
Thank you for referring this patient for diabetes education.
Your patient has attended Session 1 of our Type 2 Diabetes Self -Management group education program but did not attend Session 2.
Topics discussed during the program include: - delete topics not covered
What is Diabetes? Risk factors for developing diabetes Factors affecting blood glucose levels How glucose works and role of insulin Exercise / getting started Monitoring diabetes short and long term Carbohydrate counting/ healthy eating/fats Food label reading/recipe modification/eating out Medications/hypoglycaemia Staying well/avoiding complications GP management plan, Enhanced Primary Care and Annual cycle of care Follow up and support organisations
Your patient has been advised that regular medical review, HbA1c, fasting lipids, Micro albumin, retinal and podiatric assessment are all essential components of diabetes management.
At this stage no further appointments have been made with Hunter New England Diabetes Services.
Your patient can re-attend any time in the future should further education be required.
Regards,
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8.5 Example of GP Letter template for patients that have cancelled or not arrived to Session 1
Your patient was booked into our Type 2 Diabetes Self -Management group education program but they failed to attend/cancelled (adjust accordingly) their appointment.
At this stage they have not contacted our service to reschedule another appointment.
At this time their file has been discharged.
Please feel free to re-refer your patient in the future should the need arise. Regards, 9. APPROVED ACRONYMS AND ABBREVIATIONS
Staff documenting in the Health Records of CACS-GNS Diabetes Service may use the following abbreviations, which are NOT LISTED in The Australian Dictionary of Abbreviations, Acronyms & Symbols – hard copy and available online.
ABBREVIATION FULL TEXT ACARS Aged Care and Rehabilitation Services ACCR Aged Care Client Record ACSA Aged & Community Service Association ADHC Aging, Disability and Home Care AFC Area Falls Coordinator AFD Alcohol free day AGHE Australian Guide to Healthy Eating AL After lunch ASET Aged Care Service Emergency Teams B Bed Before bed BD Before dinner BDH Belmont District Health Service CAPAC Community Acute Post Acute Care CCAP Community Care Access Point CDGNS Clinical Director, Greater Newcastle Sector CDMS Chronic Disease Management System CDM Chronic Disease Management (pertaining to primary care plans) CFC Combined Foot Clinic CGM Continuous Glucose Monitoring CHIME Community Health Information Management Enterprise CMNH Calvary Mater Newcastle Hospital CMS Case Management Service ComPacks Community Care Packages COU Community Options Unit CRCC Commonwealth Respite and Carelink Centre DAA Dietetic Association of Australia DC& SE Director, Communication & Stakeholder Engagement DI&P Director Integration and Partnerships Dir AH Director Allied Health Dir N&MS Director Nursing and Midwifery Services DMR Digital Medical Record EACH D Extended Aged Care at Home Dementia ELCHC Eastlakes Community Health Centre EMP Empowerment Program ENCHC East Newcastle Community Health Centre FODMAPS Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols FTE Full Time Equivalent (Staff Member) GPMP General Practitioner Management Plan GNS Greater Newcastle Sector HaH Healthy at Home
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HBIS Hunter Brain Injury Service HES Hunter Equipment Service HNE Health Hunter New England Health HNELHD Hunter New England Local Health District HPOS Hunter Prosthetics and Orthotics HRFC High Risk Foot Clinic HSCIS Hunter Spinal Cord Injury Service HVPH Hunter Valley Private Hospital HYDRO Hydrotherapy HYPER Hyperglycaemia HYPO Hypoglycaemia I:CHO Insulin:Carbohydrate (ratio) IIMS Incident Information Management System i.PM iSOFT Patient Manager ISF Insulin Sensitivity Factor JFH James Fletcher Hospital JHH John Hunter Hospital KKDH Kurri Kurri District Health Service LMMHT Lake Macquarie Mental Health Team LMPH Lake Macquarie Private Hospital MCAPL Metabolic Consequences from Anti -Psychotics Liaison MCN Managed Clinical Network MDCC Multicultural Day Care Centre Man MSR&P Manager Medical Services Recruitment and Planning MNT Medical Nutritional Therapy MPH Maitland Private Hospital NCHC Newcastle Community Health Centre NDSS National Diabetes Supply Scheme PHPP Population Health, Planning and Performance RACS Residential Aged Care Service RHHS Rural Hospital & Health Service (formerly MPS) RIC Referral and Information Centre RNC Royal Newcastle Centre RPCT Respecting Patient Choices Team RPDH Rankin Park Day Hospital RTHC Raymond Terrace Health Centre SBGM Self blood glucose monitoring SCII Subcutaneous Insulin Infusion SMHSOP Specialist Mental Health Services for Older People SMS Short Messaging Service STRAS Short Term Resident Accommodation Service TACP Transitional Aged Care Package TCH Tomaree Community Hospital TLU Transitional Living Unit WH&S Workplace Health and Safety
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The following Abbreviations are listed in The Australian Dictionary of Abbreviations, Acronyms & Symbols, but they have a different meaning.
The following Abbreviations used when documenting in Health Records of CACS-GNS Diabetes Service will have a DIFFERENT MEANING as outlined below.
ABBREVIATION FULL TEXT AB After breakfast AD After dinner ACP Advanced Care Planning ADC Australian Diabetes Council AHS Aboriginal Health Service BB Before breakfast BL Before lunch CC Connecting Care CDE Credentialled Diabetes Educator CDH Cessnock District Health Service CHS Community Health Service CNS Clinical Nurse Specialist COP Community Options Project DAS Dementia Advisory Service DE Diabetes Educator GM General Manager (Sector Manager) IEP Insulin Education Program MBS Medical Benefits Scheme MD Multi-Disciplinary MDI Multiple Daily Injections MHS Multicultural Health Service MPS Multi Purpose Service (now Rural Hospital & Health Service) PA Physical Activity RCA Root Cause Analysis RIB Reportable Incident Brief RMS Roads and Maritime Services RPC Rankin Park Centre
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Diabetes Service Combined Foot Clinic
The Combined Foot clinic (CFC) is conducted on Thursday mornings from 8am. It is located at the Royal Newcastle Centre (RNC) Level 1.
It is essential to wear enclosed shoes with a non-slip sole and have identification clearly worn.
There are facilities including a fridge and microwave for your meals. There is limited secure storage for your personal belongings, so it is suggested to keep these on yourself if possible.
The majority of the patients at this clinic will have extensive neuropathic disease. This may include “Charcot’s Disease” a rare pathology related to damaged nerves in the feet. You may see large, malodourous wounds. Some of the treatments and wounds may be confronting to some people. If you are feeling unwell or overwhelmed at any stage, please let a member of the staff know and they will assist you.
The clinic is a multidisciplinary clinic. There could be representatives from orthopaedics, endocrinology, podiatry, rehabilitation and immunology present at the clinic throughout the session. Please be mindful that the treatment rooms may become very full if teams are consulting simultaneously, if this occurs you may need to vacate the room.
The diabetes educator’s role at the CFC is to provide opportunistic diabetes education and intervention as required; assess individual patient needs, plan and consult with the patient, family/carers and with other relevant health professionals in relation to their diabetes and diabetes related foot issues.
The following acronyms used in this clinic were prepared in March 2017 by Alison Wright, Carmen Holmes and Kate Carroll.
BKA- Below Knee Amputation CAM- knee high boot with Velcro fastening CNA- Charcot Neuropathic Arthropathy CROW- Charcot Restraining Orthotic Walker DART- Diabetes Foot Assessment of Risk Test FCN- Foot Care Nurse HACC- Home and Community Care HPOS- Hunter Prosthetics and Orthotics HRFC- High Risk Foot Clinic LM- Lateral Malleolus MM- Medial Malleolus MPJ- Metatarsal Phalangeal Joint MRO- Multi Resistant Organism OM- Osteomyelitis PND- Peripheral Neuropathic Disease TBI- Toe Brachial Index TCI- Total Contact Insole for orthotic shoe TCC- Total Contact Cast VAC- Vacuum Assisted Closure VP- Vacuped Boot
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Toe Brachial Index (TBI)
A TBI has been proven to be more reliable than an Ankle Brachial Index (ABI) in people with diabetes. A TBI is a comparison of the arm and toe blood pressure.
The TBI is calculated by dividing the toe pressure by the highest arm pressure
TBI = Toe Systolic Pressure Arm Systolic Pressure
0.65 – 0.7 and above is normal for TBI
An absolute toe pressure >30mmHg may be an indicator of healing potential in a foot with ulcers.
Monofilament Test
The 10 gram monofilament is used to identify patient’s sensation
Failure to detect the 10grams of pressure 6 sites or less is indicative of loss of protective sensation, known as neuropathy.
Loss of protective sensation puts patients at risk of unknown trauma and ulceration and infection. Injuries seen in the foot clinic associated with neuropathy include: burns, foreign body, insect bite, or blister from footwear.
Charcot Presentation
Charcot foot is often initially misdiagnosed as cellulitis or gout.
It is essential for long term outcomes for this pathology to be diagnosed early. If a health professional encounters a person with diabetes (Type 1 or Type 2) with a red, hot swollen foot to suspect Charcot as an underlying pathology and refer for imaging and podiatry assessment.
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Meter and Pump Downloading
You will be orientated to clinics and will have the opportunity to observe downloading before attending.
Supplies you will need:-
Black Medtronic USB stick White Medtronic Carelink USB Stick Diasend box Meter USB Cables I drive mapped to your computer
Medtronic Pump 640G Desktop Icon Medtronic Carelink Pro. Old Medtronic VEO – White Medtronic USB Stick New Medtronic 640 G – Black Medtronic USB stick Pump does NOT require suspending but must not being delivering bolus or having a temporary basal in progress.
Medtronic 640 G 1. Select Black USB device and insert into computer hard drive. 2. Open desktop Medtronic Carelink Professional by double clicking over icon 3. Select Open Patient if the patient has had their pump downloaded onto this computer before or New Patient if this is the first time for this patient to have pump downloaded.
The process for downloading the 640 G is the same as above except for the following. . After clicking read device the pump will prompt you to press the down arrow then select yes by using arrows – the pump will now download. The patients that have a Medtronic account on the internet can have their download that they have attended at home synced to the Medtronic professional desktop program by clicking on profile and adding username and password for that patients account.
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Medtronic 670G This pump is downloaded using Contour next Link meter Website https://carelink.medtronic.eu/index.html Username- GNSDiabetes Password - Sugar123
Carelink Personal account https://carelink.minimed.eu/patient/entry.jsp?bhcp=1 Patient has username and password. Carelink professional https://carelink.medtronic.eu/index.html Username- GNSDiabetes Password - Sugar123
TSlim Pump Downloaded through Diasend or Dexcom Clarity using the mini USB cord. Pump will automatically download You will be prompted to fill in patient details. https://www.diasend.com/ Username – jhadults Password - diabetesgns
Dexcom Clarity
HTTPS://clarity.dexcom.eu/ Username – antenatalclinic Password – Antenatalclinic@2
Meters All meters can be downloaded using the Diasend box by plugging the appropriate cable into the back of the Diasend box. Once the download is complete access Diasend website https://www.diasend.com/ Click on - Diasend - Glooko , 1. Open Diasend and Enter username and password Username – jhadults Password - diabetesgns
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2. Click on Clinic Tab on the top left hand corner 3. Select the correct serial numbered device, if downloaded previously the patients name will already be attached to the device. 4. Click on open selected device 5. Navigate through the tabs and select the reports you would like to print. Use print to PDF to get the best look at the reports. 6. Print reports and attach to the Doctors Outpatient Progress notes.
Passwords:
All passwords associated with any patient must be kept confidential.
Diasend – Used for downloading all Meters
Username – jhhadults
Password – diabetesgns
Ipro clinic
Website – https://ipro.medtronic .com
Username - JHHYPC
Password – JHHYPC
Freestyle Libre https://www4.libreview.com/Accounts/login?lang=enUS&country=AU
Email: [email protected]
Password: - Diabsms1
Laverty
Username – Byrnehouse
Password –JHHbyrne
Douglas
Username – Byrnehohuse
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