For those with diabetes who use insulin pump therapy, having access to training and education on this technology is key to success. David Jopke, DNP, FNP-C, BC-ADM, CDCES, Tracy Newell RD, LD, CDCES, Erin L. DaRosa, MBA, RDN, LD, CDCES join The Huddle to talk about their experiences creating a team-based formal process for becoming an insulin pump trainer, and how practice settings that want to offer insulin pumps and automated insulin delivery system options to people with diabetes can create their own formalized process. Learn more about HealthPartners here: HealthPartners – Top-Rated insurance and health care in Minnesota and Wisconsin View danatech's resources on insulin pumps & AID here: Insulin Pumps l diabetes training and education l Danatech (adces.org) Learn more about the Panther program here: Diabetes Technology. Deciphered. | PANTHER Program
For those with diabetes who use insulin pump therapy, having access to training and education on this technology is key to success. David Jopke, DNP, FNP-C, BC-ADM, CDCES, Tracy Newell RD LD, CDCES, RD, LD, CDCES, Erin L. DaRosa, MBA, RDN, LD, CDCES join The Huddle to talk about their experiences creating a team-based formal process for becoming an insulin pump trainer, and how practice settings that want to offer insulin pumps and automated insulin delivery system options to people with diabetes can create their own formalized process.
Learn more about HealthPartners here: HealthPartners – Top-Rated insurance and health care in Minnesota and Wisconsin
View danatech's resources on insulin pumps & AID here: Insulin Pumps l diabetes training and education l Danatech (adces.org)
Learn more about the Panther program here: Diabetes Technology. Deciphered. | PANTHER Program
Jodi Lavin-Tompkins
Hello and welcome to ADCES's podcast, “The Huddle: Conversations with the diabetes care team”. In each episode, we speak with guests from across the diabetes care space to bring you perspectives, issues, and updates that elevate your role, inform your practice, and ignite your passion. I'm Jodi Lavin-Tompkins, Director of Accreditation and Content Development at the Association of Diabetes Care & Education Specialists.
My guests today are David Jopke, an endocrinology nurse practitioner at Tucson Medical Center, Tracy Newell, a diabetes care and education specialist, and Erin DeRosa, the senior manager of diabetes education, who are both from Health Partners Health System in Minnesota. We're going to have a conversation about their experiences creating a formal process for becoming an insulin pump trainer using a team approach. They will share how they developed work standards, competency checklists, and standing orders, and talk about the impact of having a position as a pump coordinator. The hope is that programs that want to offer insulin pumps and automated insulin delivery system options to people with diabetes in their setting will find this information useful for creating their own formalized process. Erin, Tracy, and David, welcome to The Huddle.
Erin DaRosa
Thank you.
Tracy Newell
Thank you, Jodi. I'm delighted to be here.
David Jopke
Yes, thanks, Jodi.
Jodi
Before we get into today's discussion, could you each tell our audience a bit more about yourselves and your work as it relates to today's topic?
Erin
Sure. My name's Erin, and I have 20-plus years' experience in the diabetes space from anywhere from industry to also clinical experience in both inpatient and outpatient care. My current role is as senior manager of diabetes education. So I support over 30 diabetes care and education specialists and really come up with processes and help support them and patients as well as the health care system.
Tracy
Hi, I am Tracy, a registered dietician. I've been fortunate enough to have worked with patients with diabetes for many years. But recently, I've grown in my professional practice to offer training and education on insulin pumps and automated insulin delivery devices. Becoming a pump educator has really elevated my role and is highly rewarding. So I'm excited to empower others and share my process.
David
Hello, my name's David and I currently work as a nurse practitioner in endocrinology, also a CDCES, board certified in advanced diabetes management. I've worked in diabetes for a long time, both in industry and then more recently clinically. And my main focus historically has been really looking at ways to effectively integrate technology and how to use it. So that's really correlated to the work we're going to talk about today.
Jodi
Well, David, I'd like to start with you. And I know a lot of programs have rules and criteria they ask the person to meet in order to get an insulin pump. But I understand you put a different perspective on this, making it more person centered. So can you tell us more about this?
David
For sure, Jodi, thank you. So to be fair, think historically this idea about these kind of guidelines and things, the goalposts that people have to meet, I think ultimately from my perspective is focused around safety in terms of people with their self-management and education in terms of being able to count carbs and inject insulin appropriately and all those things. And while that has remained important and always will to some degree, like a lot of things, I think as it relates to insulin pump technology, programs need to evolve as the technologies have evolved. And a lot of things have changed in the last seven, eight years in the wake of the advanced insulin delivery systems. And when I looked at our program at the time, we were very rigid in the way that we would work with people living with diabetes in terms of those who wanted to transition to a pump. And it didn't really lead to great outcomes for both parties. From a patient perspective, many people remained frustrated and were unable to transition to an insulin pump. And then from a care and education specialist perspective, the program was very rigid and there was this kind of culture of worry about what happens if somebody starts on a pump and then something happens. And so there was this kind of inherent focus on making sure that every topic was covered according to the current program guidelines. And if those goalposts weren't met, ultimately, it just didn't turn out very well. And so really we looked at trying to chose things much more to a patient-centric perspective, really focusing on the person living with diabetes in front of you and tailoring the program to their needs.
And from a care and education specialist perspective, it was really around creating this kind of new program parameters that really opened it up for each specialist to work with the person in front of them and tailor it to what they needed. So it was much more open -ended. There were things that were created that people could use, but you didn't necessarily have to use all of it. And so I think that was really helpful in that one, the conversion rate went to a hundred percent. So basically everyone who wanted a pump ended up getting it. And then secondarily, from a diabetes care and education specialist perspective, it really opened it up for it kind of quote unquote to be okay to not follow a strict guideline. And I think the feedback for our program was, is that it was a much more kind of pleasant patient-centric approach. And so it really kind of set up our program to continue to do the work that both Erin and Tracy are going to talk about moving forward. And the work was really found or guided by kind of two perspectives. One of course was the ADCES ICC framework, which is a great framework talking about again, right patient, right technology, right time. And then also guided by a middle-range nursing theory called modeling and role modeling, which is really focused on making sure that we're kind of delivering care based on a person's worldview. So ultimately, again, I think the overall focus was less on goal posts and more working with the person in front of you.
Jodi
That's really helpful to hear and interesting that you were able to make this change and that it had such positive outcomes. So I want to move on to Erin, and just ask in your role as a senior manager in a diabetes program, you know, I imagine you work on streamlining a lot of processes and procedures to save money and time for the health system. So can you share how a structured approach for pump training helps to meet those objectives?
Erin
Sure. A few things we were trying to achieve with this approach. And when I hear you ask that question, the quintuple aim comes to mind, and I think it really fits well into this project as well. So first and foremost, as David was just speaking to, I think what really led this was the patient experience. So throughout the process, we know that a pump process can be somewhat complicated for the patient to navigate, sometimes for us to navigate with all the paperwork. But we found that especially in a system where there’s several members of the care team involved and we're not all in the same place, a clearly defined process really helps the patient and it really does save time. Secondly, if we look at the population, now more than ever, we're understanding the impact that technology has on a person with diabetes. And I'm really proud that our team has really leaned into the evidence of technology supporting this population to really improve overall wellbeing. So, it's been invigorating as a leader to be part of this team that's so innovative and willing to grow and learn. And in some ways we're learning right alongside with the patient and kind of as David talked about, it didn't feel like we needed to be experts in any one thing. We just really needed to be there with the patient and kind of help understand them and partner with them.
When you look at it from a health equity, which would be another pillar of that quintuple aim, we wanted to create choice for the patient and we try as much as possible to eliminate bias and create more access and not less, which again, David alluded to. This work is always ongoing and we know that we needed that accountability. So throughout this process, we created a small work group and we call it TEQUITY, our fun word for it. But that's a group that, it's a small work group within our department and they really do keep us accountable and they help us look at things from the patient perspective and really keep that person at the center of all the decisions. So, it's been a really fun part of this experience. If you think about that fourth pillar of reducing costs, I suppose you could view that from many different perspectives. Certainly, a more efficient process with those defined roles really does help utilize staff appropriately. We also identified throughout this process that we had some opportunity to improve the turnaround time for patients accessing pumps and follow up with the educator or an endocrinologist after, because that's really where a lot of that learning happens. It's such a rich environment to learn once they're utilizing the pump. So we knew we had opportunity and that defined process helped improve that as well.
In terms of the patient, we leveraged industry to do the pump starts, which is a free service that they offer. They know their pumps well, especially as these pumps are starting to get very complicated and technical. We wanted to leverage industry for that button pushing start, but our team does a lot of that prep for the patient and then the follow-up visits in terms of optimizing the pump. So that really did free us up our team to see other patients as well. So there's a lot of different aspects to the cost piece. And that last certainly, but not least, the care team well-being, that fifth pillar. So as a programming manager, I view this in a couple of ways. First and foremost, my team. David touched upon this, the diabetes care and education specialists provide a lot of feedback that this process of moving in this direction really made them more engaged. And that's a big goal of ours is to keep them engaged, have balance, have time to learn and grow, share their best practices, and really offer feedback as we make changes. We know they're the ones with the patients daily so that their input is really, really, really helpful. So we have pump quarterly meetings that really focus on learnings. And then we developed a new pump educator kind of lunch and learns where we would spend time with those newer to pumps to really kind of learn at their level. And the one fun part that we all did was we worked as a team and it seems like a while ago now, David, if we think about it, but we worked as a team to come up with the name of our program. We named it PATH. There was an acronym involved. So Pump And Technology Help, that's what that stands for. But also just understanding that the patient is on a path as they navigate technology. So that was kind of fun to keep them engaged. And then another part of care team wellbeing is really thinking about supporting the clinician, because they can't do it all on their own. So they really look to us for that support. It's a win-win to be able to alleviate that burden as well.
Jodi
Oh I love that. And you know what else I love about what you said is that you really examined the journey for both the person with diabetes and the care team. And then you created these fun terms like tech-quity. I love that, that you have a health equity lens on for this program. And then you applied a quality improvement perspective, which is really what a leader does, you know, for new programs in a health system. So, I mean, kudos to you. I think it sounds wonderful. So now I want to ask Tracy to get into the nitty gritty of what it's like to be a pump educator in this setting. And I think it would help our audience to hear, you know, what your approach has been. And if you could just walk us through that, I know there's so many options. How do you match the device to the person? And, you know, how do you really apply all these things as a pump educator?
Tracy
Yeah, thank you, Jodi. As a diabetes educator, you know, I already had a strong foundation in diabetes self-management, insulin therapy, continuous glucose monitoring, and the needed listening skills to provide that very important patient-centered care. So I was confident that I could develop this skill, but with any new skill, you need training and practice. So when I initially got started, what was helpful for me was to complete the ADCES danatech courses, as well as the ADCES insulin pump therapy coursework. And so that was where I started. But then beyond that, I would spend time with our more experienced pump trainers on our team, which was also very helpful. And then in my situation, it was extremely helpful to have the work standards, a pump training slide deck, a checklist to just ensure that all the topics were covered for patient preparedness and safety. But I would add, like David had mentioned, our program, we really were wanting to make it more patient centered. And so we allowed for that flexibility in our program to teach to what the patient wanted and needed to know. And of course, this is incredibly important when we're teaching to such a wide variety of learning abilities and experiences.
But with regards to what is really helping with the ICC framework and getting the right patient with the right technology, probably the most important role I felt I had initially was to learn all the unique features of the different systems out there. And in order to do this, I really relied heavily on a few things. Again, danatech, an excellent site to access for all educators wanting to know more about diabetes technology. The Panther program, that's at pantherprogram.org, as well as simulator apps, company websites, and connecting with industry partners to really help them help me understand what their unique features were of their different systems. You know, I tell patients when I'm educating or training that, you know, there are many available hybrid closed loop and AID systems out there. All of the systems will help achieve lower time spent below range and more time in range, but that really it's about finding out what that specific patient needs for their lifestyle, their personal preferences and their diabetes goals. And so some of the things that it's very important for you to understand when you're starting to do this type of work is, are there concerns for the patient? Maybe it's important that their phone would interface with the actual system and that they want a bolus from their phone. They may want to be able to disconnect from their pump or how much insulin does the pump hold? Wearability. What about a battery that might need charged? Is there a touch screen? How easy is it to fill the reservoir? Or sometimes with certain pumps, there are not any levers that you can actually control. Or for someone that likes a lot of settings or wants to do that fine tuning, some of those systems would certainly not be a good choice. So yeah, there's just really a lot of tools out there and it's a very exciting time for our patients because there are more options. Certainly, we're starting to see different systems allowing for different CGM devices. And that can be helpful depending on a patient's insurance or whether or not they may have trouble with skin irritation or adhesions. So there's just a lot to know and help the patient. Now, when the patient comes back for their return visits, what I found extremely beneficial was to review pump reports off of the different software programs before the patient arrived for their follow-up visit and review them even with other experienced pump trainers or even the industry leaders to help me better understand exactly what I was looking for.
Jodi
And so you're continuing your education as well by doing that. Before I move on to my next question, I know you mentioned the ICC framework. And I just want to reiterate what that stands for in case people in our audience who are listening haven't heard that term before. The I stands for identify, identify the right device. C stands for configure. So you want to configure the device to help that person use it the way they need to use it. And then the other C is for collaborate. So you're collaborating with the person, looking at their reports and helping them make adjustments and interpret what's going on. So I hope that helps our audience understand what ICC means as a framework. OK, now I wanted to move to Erin again. And Erin, you mentioned something about a pump coordinator role. You've also developed some work standards and competency checklists and standing orders in your program. So I was hoping you would speak to how all this works together.
Erin
Yeah. I did mention this earlier that we identified some opportunities with turnaround times, as you talked about that quality improvement project. It actually was one of ours through our accreditation. But we found that needed some improvement, follow up with either endocrinology or diabetes educator. And then when we started partnering so much with industry, we really needed to work on that communication. All those factors really influence the development of what we call the pump coordinator role. It has developed and it continues to, and really what the coordinator is is a CDCES who has dedicated time to be that single point of contact for industry and internally. So it's the person that we kind of all go to. And this role helps with tracking. It's really improved the turnaround time. It's still always going to be a challenge. There's a lot of paperwork involved. But that communication and that follow up with patients has really improved. After they start the pump again, that's oftentimes, and Tracy talked about this, there's a lot of good learning that can happen once the patient starts utilizing the technology. So that's kind of our pump coordinator role. It's been a great addition and well worth the time.
We also, you mentioned the work standards. So the development of the work standard helped us to bring all of our key partners together. In our case, that was endocrinology, it was some of the leaders, it was the diabetes education team. And what we did is the work standard is somewhat of a process that our organization has in terms of insulin pump initiation. And so it defines roles and it really ensures that we all know who's supposed to do what. And it created a lot of efficiencies for us. And it allowed us to share best practices amongst the departments as well. So that work standard that, as I mentioned, defines the process, but our standing order, and some may refer to those as protocols, that really informs our clinical work. So we've always had an insulin pump standing order that helped with our clinical work. But now with the AIDs becoming so popular, we've really identified a need and currently I'm adapting the standing order to include AIDs since each has a unique algorithm. There are certain settings that can be adjusted, certain ones that can't. Tracy, you mentioned the Panther program and danatech. I actually added links to those resources straight in our standing order protocol because they have great guidance on how to make adjustments and how to look at those reports. So we use things like that in our standing orders, resources like that in our standing orders to really help and continue to work with patients.
I mentioned our team has leaned into the evidence that diabetes technology improves outcomes. It's so exciting to hear Tracy, just to kind of think about back to how much she's grown over the last year or so with her knowledge of pumps. Well, that of course is exciting when you think about all that learning that happened. But it does come with a unique set of challenges, because when you have a very experienced group of educators with the pump and a separate group who's just learning, this is where I would say we had a lot of learning and did a lot of adapting, because we were observing things like when the new pump learners were getting in a room with the experienced pump learners. I can tell you that talking about pumps and how you can problem solve with patients is a lot of fun. And sometimes those conversations would get quite technical and some of those new learners could get lost in some of those details. So what we did is, we did two things. One, we created the insulin pump educator competency. So this is where a learner moves through a process, more of a structured process of learning. And to be honest, I look to you, Tracy, and kind of the feedback from you of how you were learning, because she really did use her resources in a really creative way to learn. So we took a lot of that feedback and put that into a competency. And then we also started separate pump meetings and we did this kind of over lunch, a lunch and learn just for the new members. So lots of little things coming together to really help it be a smoother process for the patient and the educator.
Jodi
Well, thank you for that overview, Erin. And this has been a great overview of how to structure a successful pump educator program. Thank you all for sharing your great work on this. You know, we started off this conversation with David explaining his philosophy of how to approach this in a person-centered way. Then we moved on to Erin talking about the structure for the program and some of the tools that you created to make it work for the team. And then Tracy shared with us how she is a role model for pump education and how the role of the pump educator works. And so David, I'm going back to you to see if you have any closing thoughts you would like to share with our audience.
David
Thanks, Jodi. I think we've discussed kind of the idea of teamwork. You know, I just can't say that enough. Being somewhat removed from both Erin and Tracy now as I've expanded my role, it just, I really marvel at kind of how this program has continued to develop. After the initial work that I did and just kind of hearing Tracy's experience and what she's doing now, it's just a great reminder of what started, you know, based on my work has only grown more. And it's really a testament to the team and really kind of some leap of faith because the whole culture around our program changed with that beginning work. And it took a lot of trust between all of us to really continue to grow where it is. And so it's just great to see how it's continued to evolve and I'm sure will continue to evolve. So I would just say that again, the idea of teamwork and what it's meant to that program, this program has been paramount. And I think that's true of any diabetes education program.
Jodi
All right, well, David, Tracy and Erin, thank you so much for taking the time to join us for this episode of The Huddle. You've given us some very valuable insights into developing a person-centered insulin pump trainer program that the whole team participates in. And we want to thank you for sharing your knowledge and experience with our audience.
Erin
Thanks, Jodi, for having us. It's been a pleasure sharing.
Tracy
Thank you, Jodi.
David
Yes, thanks, Jodi, for the opportunity to discuss these topics today.
Jodi
Thank you for listening to this week's episode of The Huddle. Make sure to download the resources discussed in today's episode. You can find them linked in the show notes at adces.org/podcast. And remember, ADCES membership gets you free access to resources, education, and networking that improve your practice and optimize outcomes for your clients. Learn more about what ADCES could do for you at adces.org/join. The information in this podcast is for informational purposes only and may not be appropriate or applicable to your individual circumstances. This podcast does not provide medical or professional advice and is not a substitute for consultation with a health care professional. Please consult your health care professional for any medical questions.