Diabetes mellitus is a metabolic disorder prevalent globally. It can lead to serious complications if left untreated and unmanaged. The individualized case management programs exist in the hospitals and community settings. These programs direct the patient for managing diabetes with controlled diet, exercise and insulin. The case management programs for diabetes encompass best practices, published guidelines and clinical pathways so that the patient may benefit maximally.
Best practices
Best practices in any disease management program are derived from the repeated practices/procedures that lead to best outcomes. These are evidence-based practices recommended by healthcare practitioners so that the patient may receive the best result of the treatment or intervention. Best practices in diabetes include patient education, patient self-management methods, diet and exercise plans. The best practices in acute diabetes care include ambulatory stabilization and diabetes education. Further diabetes complications assessment and diagnostic services are recommended by the nurse practitioner. Best practices also include the appropriate referrals to dietitian, cardiologist or psychologist if required by the patient. Recording and monitoring of the patient is the most important practice to be followed by the nurse practitioner.
Published guidelines
Published guidelines are an important element of case management plans as they provide a spectrum of information about the disease to the patient. These guidelines are issued by various national and international agencies & organizations, and provide relevant information about case management plans. Some published guidelines for diabetes include American Diabetes Association’s Clinical Practice Recommendations, Diabetes Nurse Practitioner Guidelines by Royal Prince Alferd Hospital and Joslin Clinical Guidelines from the Joslin Diabetes Center (Wolber & Ward, 2010).
A short summary of these guidelines is as follows: In the case of mild diabetes, insulin therapy can commence, and oral fluids may be recommended to the patient. Supplemental doses of insulin can be given to treat the ketonuria in case of moderate diabetes. Additionally, fluids with potassium and other electrolytes can be given. Severe diabetes may require hospitalization and insulin infusion. IV fluid replacement may be commenced, and the patient must be kept under continuous observation. Intercurrent infections may be treated on an urgent basis in the case of severe diabetes. During the early management period, initial education should be given to the patient and the family. The basis for diagnosis should be explained, and immediate need for insulin should be discussed. The patient should be assisted in his/her first insulin injection and should be educated about blood glucose monitoring. Diet advice may also be given if appropriate. Patient’s response to treatment should be checked in the initial follow up. Ketone and glucose levels of blood should be reviewed, and insulin therapy should be adjusted, if required. In the first year of diabetes, the patient should be reviewed every 3 to 4 months. Assessment of glycemic control, injection sites, insulin regimens, dietary management, etc. should be done as part of ongoing care (Overland & Brooks, 2005).
Clinical pathways
Clinical pathways are an important tool for high-quality evidence-based care. These pathways provide a set procedures and timelines to follow while implementing healthcare in diabetes. Diabetes clinical pathways serve as a planning mechanism and divide the care into several stages. Stage one includes the patient education of the newly diagnosed patients. Stage two (initial management) involves the clinical tests, analysis of reports and beginning of the treatment. Stage three (on-going management) includes the treatment/interventions and self management by the patient. It may involve the expected dates of new medicines, details of procedures and diet & exercise plans. Stage three is again followed by stage two ensure the efficacy of the intervention. Clinical pathways help the patient to know about their own stage and inform them about the next one. These pathways offer a more organized & efficient diabetes care and can be adapted to different patient settings. Overall, the care pathways in diabetes improve care and multidisciplinary communication (O’Brian & Hardy, 2003).
Diabetes can be managed proficiently with the help of established best practices, published guidelines and clinical pathways. These three modules of a case management plan present a standardized and effective diabetes management. These modules educate the patients regarding their own disease & its management and help them to make informed decisions about their diabetes care.
References
O’Brian, S. V. & Hardy, K. V. (2003). Developing and implementing diabetes care pathways. Journal of Diabetes Nursing, 7(2), 53-56.
Overland, J. & Brooks, B. (2005). Diabetes nurse practitioner guidelines: Role and scope of practice. Diabetes Centre, Royal Prince Alferd Hospital, 1-69.
Wolber, T. & Ward, D. (2010). Implementation of a diabetes nurse case management program in a primary care clinic: A process evaluation. Journal of Nursing & Healthcare of Chronic Illnesses, 2(2), 122-134.
