Stacey Seggelke, MS, RN, CNS, CDE, BC-ADM Stacey Seggelke, MS, RN, CNS, CDE, BC-ADM

 

Stacey Seggelke, sees patients with diabetes both in and out of the hospital, and shared her experiences at the Kindred Clinical Impact Symposium. She is a member of the inpatient Glucose Management team at the University of Colorado Hospital and has an outpatient diabetes clinic one day per week.

There has been a steady and significant increase in diabetes over the last 30 years. It affects 8 percent of the population, and it is estimated that there are 79 million people who are pre-diabetic. Even when it is not the primary diagnosis, diabetes impacts the care provided to the person, and Seggelke works with her patients from admission to discharge to make sure that the treatments for other medical issues don’t harm the patient or cause problems related to their diabetes.

She starts off with the basics, talking to the patient about the type and duration of his or her diabetes. Some of this information could be found in the medical records, but the discussion helps Seggelke assess the patient and family’s need for diabetes and nutrition education and assess their competency in managing diabetes medications.

While the patient is in the hospital, Seggelke coordinates with other providers to help mitigate issues that arise from their treatments. She gives the example of patients who need tube feeding, which can cause hyperglycemia, or patients who are prescribed steroids. While the current guidelines say that means blood sugar greater than 200, in the diabetes world, that’s very high. (High blood sugar for a diabetic is generally greater than 180).

In addition to working with others on the care team, she continues working with the patient and his or her family. For patients who maintain control over their blood sugar well at home, the spikes caused by medications can cause stress and feelings of guilt. It’s important to let them know when the issues are not their fault, and why it is happening. There are other complications such as slow wound healing that can arise as a result of diabetes and/or high blood sugar, and these need to be monitored as well during the patient’s stay.

Once a patient is ready to go home, Seggelke prefers a collaborative approach. She notes that people are overloaded with information at discharge and a big shift is occurring where the patient is going to have to self-manage. Seggelke will assess their level of understanding related to the diagnosis and their self-monitoring of blood glucose. Patients need clearly written instructions and should receive an insulin-specific discharge form. They should be able to demonstrate drawing up and administering insulin. It’s also important to find out who is responsible for meals at home and if the patient will need dietary supplements.

Seggelke noted several times that every patient encounter is a teaching opportunity. For her hospital patients, that opportunity is there from admission to discharge. To make sure the patients understand all of the information they receive during their stay, Seggelke recommends:

  • Using graphics/pictures
  • Using a variety of media
  • Using the “teach back” method to assess understanding
  • Checking for patient understanding

Resources Seggelke recommended the attendees included:
American Diabetes Association
International Diabetes Federation

Managing Patients’ Diabetes from Admission to Discharge and Beyond