Teamwork And Diabetes Mellitus

26.10.05

Goal: "In the successful treatment of diabetes, the patient, the nurse, the practitioner and the specialist are often partners working together to establish the patient's health." RD Lawrence, 1932.

Historical development of diabetes education
• 1920s - insulin discovered.
• 1970s-80s - education recognised.
• 1990s - health promotion movement
-DCCT (1993)
-UKPDS (1998)
-global epidemic, leading to increasing expenditure.
• NOW - holistic strategy - Diabetes Care Model - "expert patients."

Today
• New health and social care policies.
• Evidence-based practice.
• Patient-centred care.
• 'Seamless' service delivery.
• Teamwork and collaborative practice.
• Overlapping of skills and competency.

DIABETES NSF: STANDARD (December 2001)
1. Empowering people with diabetes.
2. Inequalities in care.
3. Inpatient management.
4. Management of type I.
5. Prevention and management.

Diabetes care
1. Health promotion for populations to prevent diabetes.
2. Screening.
3. Ongoing management.
4. Regular examinations.
5. Ongoing treatment.
6. Treatment and management.

Chronic disease model
• Continuous, not episodic.
• Proactive, not reactive.
• Planned, not sporadic.
• Patients centred, not provider centred.
• Population based, as well as individual based.

Team members in treatment of diabetes

THE PATIENT

Community partners:
• Family/friends.
• Diabetes support groups.
• OHN/employers.
• Minority organisations.

Primary care team:
• Practice nurse/nurse practitioner/general practitioner.
• Dietician.
• Chiropodist.
• Orthoptist.
• Dentist.
• Pharmacist.

Secondary care team:
• Diabetes specialist nurse.
• Diabetologist/endocrinologist.
• Dietician.
• Chiropodist.

Other team members:
• Ophthalmologist.
• Cardiologist.
• Vascular surgeon.
• Nephrologist.
• Accident and emergency staff.
• Neurologist.
• Midwife/obstetrician.
• Psychologist.
• Physiotherapist.
• Occupational therapist.

Aims of care
• To achieve optimal glycaemic/lipid/blood pressure control.
• To delay onset and progression of diabetic complication.
• Quality of life acceptable to individual.

Major complication of diabetes
• Ketoacidosis in type I.
• HONC in type II.
• Nephropathy (kidney disease).
• Impotence (nervous system - sexual function).
• Diabetic retinopathy.
• Hypertension.
• Coronary heart disease.
• Stroke.
• Neuropathy (nervous system).

Living with diabetes
• Psychological impact: 'coming to terms' with having diabetes [nurse practitioner/practice nurse/diabetes specialist nurse + internet/magazines/books/other patients].
• Monitoring daily diet [dietician].
• Daily measurements of blood glucose levels [nurse practitioner/practice nurse/diabetes specialist nurse].
• Regular visits to hospital/GP [diabetologist, GP, diabetes specialist nurse/practice nurse, chiropodist, orthoptist].
• Regular activity/exercise [exercise physiologist/physiotherapist].
• Daily tablets and/or injections [pharmacist].
• Work, rest, play.
• Worry about future - complications.

Functioning teams
• Same goals.
• Communicate well.
• Co-operate.
• Help each other.
• Want achievement for team and patient.

Success rests on
• Quality of leadership.
• Clarity of goals.
• Effective communication.
• Motivation.
• Conflict resolution.

What do I need to know?
• Specialist knowledge/skills.
• Roles and responsibilities of others.
• Inter-disciplinary working.
• Audit.