Info on AIM Diabetes Management Team Clinic VC Room 219

With Mirabel Jimenez, RN

 

There are usually 7 patient’s registered from 9 to 12pm, the first and last slots are for new pts.  The pace of the clinic is quicker and more focused than usual PCP visits. Patients are registered in Module 224.  Once registered, you will be able to see any arrived pts under Eclipsys List under “ALL” (Do not confuse patients that are registered for the AIM DSME clinic). The pt charts are located in a black plastic wall bin in 224.  Bring the patient from the waiting room to diabetes clinic room (Room 219).    

 

In eclipsys open and write an “Ambulatory Diabetes Note”. We will focus on these items below during the visit

 

1.      Review Past medical hx with a focus on diabetes

a.       clarify pt’s understanding of their diabetes and treatment

b.      clarify diet hx, carb intake, food habits

2.      Review glucose log book and/or glucometer result –review glucometer technique for new DM pts

a.       Elicit hx and symptoms of hypoglycemia/hyperglycemia

b.      Ask pts about causes of extreme values

c.       match fsg log w glucometer results/time (sometimes there may be a disconnect)

3.      Review medication list and actual use at home

a.       clarify hx of adherence, check Rx bottles

b.      Techniques of insulin injection (inaccurate insulin injections are common)

4.      Trend A1c using amb dashboard view in iNYP  (hover over hx button to see all past A1c)

5.      Review health maintenance

a.       Last eye doctor visit, refer if needed

b.      Last podiatrist visit, refer if needed

c.       Vaccination - flu, pneumo or prevnar shot, shots are given by RN in 224

6.      Identify barriers-   Out of control diabetes is often a marker of other barriers to good medical care. These include financial, health literacy/cognition, vision, distrust, mental health wellness etc…  Consider referring pts for additional help   DSME, social worker, nutritionist, home community workers...  Any referrals need to be placed in Eclipsys and 224 staff will schedule appts. Telephone number for 224 is 212 305-0822.

7.      Ensure refills-Ask if patient needs any medication or diabetic supply refills.  There is a RX writer located on the bottom shelf on your left side.   The ACN Rx favorite list has a lot of common DM Rx orders. Common prescriptions used in AIM are lancets, needle pen tip, alcohol, gauze, test strip, mix insulin, basal insulin, prandial insulin, sitagliptin, Glucophage, glipizide

8.      Present the case -Once you have finished consulting with the patient, you must present to a PIC.  You  can choose to speak to any PIC available.  Sometimes if the patient’s PMD is available as the PIC, the resident decides to speak to that particular attending.

9.      Communicate w PCP, sometimes we need more help from PCP to help the pts on challenging cases.  C your plans w the PCP by right clicking on the completed DM note to SHMs back to PCPs.

10.  RTC- Make sure that you put in appointment request for next diabetes management clinic follow-up.  If there are any changes in medication, it is usually recommended that he/she is seen within 2 weeks. Otherwise depending on PMD’s next visit patient then you can request 1-2 months.      

11.  Superbill -complete a superbill for the visit and bring the pt back to 224 to pick up the next pt.

  

 

Other random facts

·         Log books and log sheets both in English and Spanish are located on top of the refrigerator. Juice and crackers are near the entrance fridge

·         Refer type 1s to Naoemi Berrie, we will will see pt until they have an appt

·         If pts are late, the PFA in 224 will let you know. VC224 x # 0822   DM room x 4335

 

Please speak to Ms. Jimenez or Dr. Chang for any questions on this clinic experience.