Authors (including presenting author) :
Tsang KW(1), Chan CY, Ho WLW(2), Wu CY (3), Yip HM (4), Li WI (5), Wan KY, (6) Leung MYR(7), Ho SF(8)
Affiliation :
(1)RN, (2)APN, (3)RS, (4)Resident, (5)Dietitian, (6)AC, of Lady Trench General Out-patient Clinic (LT GOPC), (7)WM (8)DOM of Family Medicine & Primary Health Care, Kowloon West Cluster
Introduction :
Operating 365 days a year, LT GOPC is managing more than 200 patients with T2DM on insulin therapy. This figure is rising. They are at high risk of complications such as hypoglycaemia, and require frequent follow-up for nursing care. Pre-existing diabetes mellitus individual counselling (DMIC) dealt with T2DM patients with or without insulin therapy. The waiting time and follow-up intervals were over 16 weeks. Although a team care approach was adopted to handle those patients on insulin therapy, they still needed to have frequent clinic visits to attend nursing or dietitian appointments between doctor consultations. In addition, T2DM patients requiring insulin initiation were also referred to the same DMIC for education. A high default rate and inappropriate utilization of quotas were observed.
Objectives :
1. To minimize waiting time for education service on insulin initiation
2. To minimize the frequency of clinic visits
3. To enhance quota utilization to cope with expanding service need
Methodology :
A workgroup is formed by specialty nurses, doctors, and a dietitian. All cases waiting in the pre-existing DMIC were screened and triaged to two new services. (1) Patients already on insulin therapy are followed-up in new DMIC for insulin therapy (RDNS) for more timely and better nursing care. (2) An Insulin Motivation Group is established for patients requiring insulin initiation, to provide timely education and promote their acceptance on insulin therapy. Patients already on insulin therapy are invited to share their experience, which could allay the anxiety and barriers of participating patients on insulin therapy. These patients could be arranged to have follow-ups with nurse, doctor and dietitian on the same day.
Result & Outcome :
In Q4 2019, 27 patients were triaged to the Insulin Motivation Group. The waiting time of RDNS service is reduced from 16 to 6 weeks. 18 patients had follow-up with doctor and nurse, and 12 patients with nurse and dietitian on the same day. 51 patients participated in the Insulin Motivation Group. They had positive feedback towards the program. Acceptance on insulin therapy increased.
