Registed Nurses' Association of Ontario

Developing evidence based strategies to address pre diabetes in a Cardiac Care Institution

Sandhya Goge
University of Ottawa Heart Institute

The University of Ottawa Heart Institute (UOHI) is an academic tertiary cardiovascular health centre, known for its excellence in patient care, education and research in cardiovascular diseases. I work as a Diabetes Nurse at UOHI. This fellowship spanned from April – September 2014. The overall goal of this fellowship was to develop leadership skills in program management and evaluation by successfully creating evidence based strategies to address prediabetes in the cardiac population at UOHI.

I accomplished this goal by participating in the following learning activities:

  • I acquired knowledge and skills in a current evidence based practice care for the prediabetes population. I conducted literature search and reviewed the clinical practice guidelines from the Canadian Diabetes Association (2013) for prediabetes management.
  • I participated in a number of activities to increase my knowledge on current diabetes practices at UOHI. I reviewed the Diabetes Management medical directive implemented throughout UOHI. I shadowed Kimberly Twyman, APN – Diabetes, to learn about the inpatient management of diabetes and various resources that are in place to ensure the smooth transition home for patients with diabetes. I also shadowed Dr. Amel Arnaout, Endocrinologist, at the UOHI Diabetes Clinic to understand outpatient management of diabetes.
  • Under the guidance of the mentoring team, I increased my knowledge and skills in program design and development through the creation of a strategy to address prediabetes at UOHI. The pre-existing diabetes medical directive was modified to include prediabetes (Appendix 1). As part of this initiative, I created an information pamphlet on prediabetes (Appendix 2). Patients admitted with a HbA1c of 6-6.4% were provided with this pamphlet along with a referral to a community prediabetes education program. An online letter was developed and added to the patient’s electronic chart on vOacis. This letter (Appendix 3) serves as a communication tool for the inpatient management team. It is electronically sent to the patient’s primary care provider notifying them of the prediabetes condition, actions taken as well as an algorithm cited from the Canadian Diabetes Association practice guidelines on how to screen this patient for diabetes in the future.
  • I learned about implementation strategies and change management by reviewing Chapter 4 of the RNAO Implementation Toolkit. To disseminate this new initiative, we created posters to put on each unit and educated staff nurses throughout UOHI. We also have Diabetes Champions on each unit who further assisted in disseminating this initiative. A laminated pocket card (Appendix 4) summarizing glycemia management was also developed for new residents and trainees. Kimberly Twyman, APN – Diabetes, also conducted educational sessions with the residents on the proper use of this new revised medical directive. An electronic version of this pocket card will be made available on vOacis.
  • I learned about program evaluation by continuing to collect patient level data on the prediabetes population at UOHI. We are in the process of connecting with our community partners to create a strategy that would allow us to follow this high risk population for a longer duration. The goal of this initiative is to assess whether an early detection of prediabetes delays and/or prevents the onset of type 2 diabetes.
  • I enhanced my presentation skills by submitting and presenting our abstract on Prediabetes Management at a Cardiac Care Centre at Canadian Council of Cardiovascular Nurses in Vancouver October 2014 (Appendix 5)
    This is my third RNAO fellowship and like the previous two, it was a great learning experience. I wish to thank my mentors for their assistance in guiding me through this fellowship. A special thanks to Kimberly Twyman, APN – Diabetes, for providing her guidance and expertise in implementing such an innovative initiative at UOHI. Last but not least I would also like to thank RNAO and the Government of Ontario for continuing to create such an excellent opportunities for nurses.

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