Microsoft word - prioritizing clients with diabetes 31-8-08 .doc

Guidelines: Diabetes Nurse Educator Intake
Priority Tool
PRIORITY 1 CLIENTS:

Priority 1 clients will preferably be contacted by a Diabetes Nurse Educator within 24
hours. If this is not possible the client will be contacted by a Community Health
Nurse or other clinical health professional within 24 hours.

Initial assessment will be undertaken by phone or face to face at the time of first contact.
Based on the outcome of this initial conversation an appointment will be made with the Diabetes Nurse Educator immediately if warranted or within 7 working days.
If the assessor is concerned about the client’s condition and a diabetes nurse
educator is not available contact should be made with the client’s G.P. for advice or
alternatively the client should be referred to emergency if indicated.
Notes: 1.
Individuals
NEWLY DIAGNOSED WITH TYPE 1, WHO ARE SYMPTOMATIC
AND HAVE MOD-LARGE BLOOD OR URINE KETONES need to be medically
assessed and commenced on insulin immediately. (a).
At present these clients should be referred to the hospital emergency
department for immediate treatment and admission as currently
insufficient support structures are in place to enable such clients to be
managed safely in an outpatient setting.
individuals should be detected on the Diabetes Educator Priority Tool 2. The following clients need to be commenced on insulin within 24 hours.
(a) Those who are newly diagnosed with Type 1, only mildly
symptomatic, with less than small blood or urine ketones and who
have been medically assessed as being clinically suitable for
outpatient stabilisation.
(b) Those who are newly diagnosed with Type 2, symptomatic and
have been medically assessed as clinically suitable for outpatient
stabilisation.
N.B. These clients can be managed in an outpatient setting provided a coordinated, planned programme of comprehensive assessment, concurrent clinical care, education, skills training and support is available as well as a multidisciplinary team to support the client and 24 hour access to clinical advice. 3. Women who are pregnant and have diabetes including gestational
should be referred as soon as possible to an antenatal clinic for
specialised management of both their pregnancy and their diabetes.
(a) If the woman has gestational diabetes and blood glucose levels
remain elevated despite adequate diet and physical activity, based
on a medical assessment she should be commenced on insulin
within 1-5 days. (e).
(b) Women with Type 2 diabetes taking OHA who become pregnant will
need to be commenced on insulin within 48 hours. (f)
MNeale: (BCHC) in consultation with Diabetes Steering Committee: 31/08/08 Guidelines: Diabetes Nurse Educator Intake
Priority Tool
PRIORITY 2 CLIENTS:

Will be contacted by the Diabetes Nurse Educator, Community Health Nurse or other
clinical health professional within 1 - 5 working days.
Initial education and assessment will be undertaken by phone or face to face at the time of first contact. Based on the outcome of this initial consultation an appointment will be made with the Diabetes Educator within 1-4 weeks. The client may also be booked into the “Caring for Diabetes” education group if appropriate.
Notes:
1. Individuals with Type 2 diabetes who are not dehydrated nor severely
symptomatic may commence insulin therapy (based on medical
assessment) within 2 – 4 weeks. (g).Also See (b).
2. Clients who are having difficulty getting to appointments may be
socially isolated, live alone or have poor family support. Such clients
may benefit from an alternative service provider who can provide
education and support in the client’s home such as district nursing.
PRIORITY 3 CLIENTS:
Will be contacted by the Diabetes Nurse Educator, Community Health Nurse or other
clinical health professional within 7 working days.

Initial assessment and education will be undertaken at that time. Unless otherwise indicated
Clients with Type 2 diabetes will be offered enrolment in the “Caring for Diabetes” education
group followed by an individualised appointment within 4 - 8 weeks of the completion of the group. If assessed as not being suitable for group education an appointment will be made as soon as practicable within 4 – 8 weeks.
1. HYPOGLYCAEMIA.
Severe hypoglycaemia is only possible if clients are taking insulin or an oral
diabetes medication (OHA) that is an insulin secretagogue such as a
Sulphonylurea or a Meglitinide. Metformin, Avandia, Actos, Acarbose, Byetta &
Januvia do not cause severe “hypos” when used alone. Client’s not on insulin
or insulin secretagogues who are experiencing “hypo” like symptoms should
be reassured, encouraged to rest and to eat a low GI carbohydrate food such
as a piece of fruit.

CLIENTS WHO ARE UNWELL.
Refer to “Guidelines for Sick Day Management for People with Diabetes.”
Australian Diabetes Educators Association (ADEA) 2006. All versions can be
downloaded or ordered from the ADEA free of charge.
Website: www.adea.org.au

MNeale: (BCHC) in consultation with Diabetes Steering Committee: 31/08/08 Guidelines: Diabetes Nurse Educator Intake
Priority Tool
References:
Australian Diabetes Educators Association. National Standards for the Development
and Quality Assessment of Services Initiating Insulin Therapy in the Ambulatory
Setting. 2004. ADEA. Canberra.
(a).Page 17, 2.1 (b).Page 13, 1.2 (c).Page 17. 2.2 (d).Page 17. 2.3 (e).Page 17. 2.5 (f).Page 17. 2.6 (g).Page 17.2.4 Australian Diabetes Educators Association. Guidelines for Sick Day Management for
People with Diabetes. 2006. ADEA. Canberra.
Australian Diabetes Educators Association. Guidelines for the Management and Care
of Diabetes in the Elderly. 2003. ADEA. Canberra.
MNeale: (BCHC) in consultation with Diabetes Steering Committee: 31/08/08

Source: http://www.chpcp.org/resources/Prioritizing%20clients%20with%20diabetes%2031-8-08%20(1).pdf