On this episode of The Huddle, Chris Memering, MSN, RN, CDCES, BC-ADM, talks about the value that diabetes care and education specialists bring to the inpatient care setting. She outlines the importance of continuity of care between the inpatient and outpatient setting, how DCES in inpatient help increase patient satisfaction and safety, and how others in the inpatient setting can demonstrate their value to their hospital leadership. Learn more about how to showcase the value of the diabetes care and education specialty in our value toolkit created especially for ADCES members. Log in here to view the toolkit: Showcase Value Toolkit Or click here to become an ADCES member to access helpful resources like this one: Membership Learn more about ADCES' inpatient certificate program focused on knowledge and skills necessary for effective inpatient diabetes care: https://www.adces.org/store/certificate-programs/detail/inpatient-certificate-program-transforming-care-and-enhancing-lives
On this episode of The Huddle, Chris Memering, MSN, RN, CDCES, BC-ADM, talks about the value that diabetes care and education specialists bring to the inpatient care setting. She outlines the importance of continuity of care between the inpatient and outpatient setting, how DCES in inpatient help increase patient satisfaction and safety, and how others in the inpatient setting can demonstrate their value to their hospital leadership.
Learn more about how to showcase the value of the diabetes care and education specialty in our value toolkit created especially for ADCES members. Log in here to view the toolkit: Showcase Value Toolkit
Or click here to become an ADCES member to access helpful resources like this one: Membership
Learn more about ADCES' inpatient certificate program focused on knowledge and skills necessary for effective inpatient diabetes care: https://www.adces.org/store/certificate-programs/detail/inpatient-certificate-program-transforming-care-and-enhancing-lives
Jodi Lavin-Tompkins
Hello and welcome to ADCS'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. I practiced as an endocrinology nurse practitioner for many years, and I'm currently ADCES's Director of Accreditation and Content Development.
Today, I'm talking with Chris Memering, an inpatient certified diabetes care and education specialist with Carolina East Medical Center in New Bern, North Carolina.
Chris, as an inpatient CDCES, I wanted to ask you, what are the areas that you can impact the most in terms of providing value to your hospital and overall health system?
Chris Memering
So the value as an inpatient diabetes care and education specialist that I offer, I believe, starts with the patient. I help to improve the safety of the care that they have here at the hospital. I help to improve their satisfaction. Because I live in the world of diabetes, I tend to speak the same language they do so that we can have a meaningful conversation about their care and how that might differ in the hospital versus home. From the hospital standpoint, I can actually help reduce readmission rates, we can decrease the length of stay, help with things like reduction in surgical site infections, other nosocomial infections, and just make sure that overall care of the person with diabetes is well-rounded and patient centered.
Jodi
Okay, and if applicable, could you spend some time talking about the handoff between you and the inpatient setting to the DSMES program?
Chris
So it's not just the DSMES program, but that's definitely a great area that we see working from an inpatient side to an outpatient side. We always talk about that transition of care and trying to make sure that everyone on the health care team, whether that be the providers in the hospital, outside the hospital, the local pharmacist, has an idea of anything that may have changed with the patient in terms of their diabetes. So I do spend a good amount of effort in making sure that those transitions of care are there. So I will send messages to our primary care doctors, to the local DSMES program, talk with the pharmacist if there's someone who's having a little bit of trouble and we think that they could benefit from that local touch point in between office visits. I work with the endocrinologists in the area and make sure all of them know that their patients have been in the hospital. We have quite a few in different practices, but I think it's really important that there is that continuity of care between an inpatient and an outpatient side. And that's not always possible when someone comes in the hospital. You might get a discharge summary sent to somebody, but taking that extra step or that extra piece of care to help with that transition has really helped build trust between the outpatient doctors and the inpatient team and myself. And they get to know that we're making adjustments here because of something that we've had a really close look at in the hospital, which is really helpful, especially if sometimes our patients don't get to see their endocrinologist, but every six months or every year, just because of resources. And the same thing for the DSMES programs. We've got a wonderful one at an independent pharmacy who really looks at their community at large and we're able to work on, “hey, your patient's here, what can I do to help?” And vice versa, back and forth with that. So we really help with those transitions of care and making sure that continuity stays high, which leads to better outcomes for that person.
Jodi
When it comes to the new CMS electronic quality standards, or the ECQMs, that will soon be required for hospitals to get paid, could you talk about how you could use those to show your value?
Chris
Yeah, so I know we're all just dipping our toes in this. But these new eCQMs are looking at rates of hypoglycemia and hyperglycemia within the hospital and what might be causing that. And is it something that the hospital itself may be doing? So for me, if we're getting hypoglycemia and we're realizing it's a timing between a blood sugar check and insulin dosing or we've got hyperglycemia because of steroid use for any particular reason. We can look into that data and really figure out how we can have better care and better care then leads to lower lengths of stay and better outcomes. And all of that data from the eCQMs are really gonna put a light and a focus on diabetes that hasn't been there before. So we're gonna be able to understand how that care in the hospital really impacts overall health. So for me as a diabetes care and education specialist, it's important to have me here to then help the staff understand what that data means and where we can make better, safer care for our patients from our providers down to our nursing assistants. So our providers and how they're ordering medications and which medications we should not use when in the hospital, what we should look at a little bit more tightly, depending on the situation for a person. My experience as a diabetes care and education specialist, that education part is not just for patients, right? It's for staff and for other members of the care team as well. I can be that expert in the room for the subject matter of diabetes and we can look at how we are planning our care, what we can do to make things better and just help the entire team understand their role in that.
Jodi
All good points. With the release of new and powerful diabetes technologies all the time, does this present an opportunity for showcasing your value and your role?
Chris
Yeah, wow, diabetes technology, talk about a snowball. It's coming fast and furious for sure. I've always thought that the diabetes care and education specialist is the technology expert. Not only do we understand the disease of diabetes really well, but we also understand the mental piece of it all, the actions that people go through every day. And I think we've worked hard to understand that. And one of these parts is the technology and understanding how our technology has advanced so quickly to really help people with managing their diabetes and hopefully reduce the burden a little bit as well. So in the hospital, I'm the expert. If there's a pump, I go see the patient. If there's a continuous glucose monitor, I go see the patient. We talk about what the numbers and what the values in the pump, what they may see. And on the continuous glucose monitor, we talk about what benefit it may come for a patient, how they may be able to understand that their glucose is a roller coaster that moves all day long and not just that first number in the morning. And once they start to see those numbers, they really get more in tuned with managing their diabetes. The training piece is we, especially my area, it's a smaller area. I have a few endocrinologists, but there's not a lot of me in the outpatient world.
Not only do we talk about the options, but we've also been able to participate in a hospital discharge program for CGMs. And it gives them that opportunity to understand what their sugars may be doing throughout the day, how their medications affect it. For some people, it becomes the safety part. They've been experiencing a lot of low sugars that are waking them up in the middle of the night. So we're able to help be that safety net and they feel more comfortable with their diabetes and adjustments to their medications or whatever they've come to the hospital for. We can talk about when you're sick and we have to readjust dosing because you're sick and how that might look in your pump. I work with our outpatient endocrinologist pretty closely when that happens so that we can make more informed decisions with the different medications that we may need to start coming from the hospital depending on what's going on with the person.
But then I'm also the trainer and expert again for staff. So not just diabetes, but also the technology. I think I may get asked the question five times a week, “why don't the meter and the CGM match?” And then we get to explain how the technologies are different and that a CGM is not just the number on the screen, that it deals with where the glucose has been, where the glucose is predicted to go, and how you can use all of that in managing diabetes. We do some of that education with our staff as well. And because we've been able to start and do some of that training and give some of that education in the hospital, now my primary care doctors are more apt to use it with other patients that they see. And it's really helped. I'll see patients who are like, “yeah, I put one on for that provider previously.” And now somebody else that I've never seen before who got a chance to get started because the provider saw just how much it was helpful with management and just understanding for everybody what was affecting that person's diabetes.
Jodi
Chris, it seems like we need a lot more of you! Do you think your administrators and hospitalists in general see your value for all that you do?
Chris
I know my hospitalists do. I've had them tell me a lot in the past few weeks. I don't know if we're just very full or what's going on, but I have had my hospitalists, and especially, we have a whole brand-new batch of hospitalists. So these are fairly young doctors just out of residency. And the beautiful thing is they have had the opportunity where they train to work with other diabetes care and education specialists. So they were very excited to know that they had one here when I introduced myself, and they are open to learning more about diabetes and diabetes care and how it may change depending on the person that's coming in. It's a very different area than where they came from. Diabetes is a little different here sometimes. I know it sounds weird, but it's a little different in Eastern North Carolina. And just culturally pieces can be different with some of that. So it's great that they're so open to all of that. I definitely get that “I appreciate you” a lot, which is fantastic. I think that hospital administrators need to really understand the value that we bring both in cost reduction through better outcomes and length of stay, but also the patient satisfaction and the patient safety part. And I know we're all very big on the safe care of our patients, but it's safe care of our patients in the hospital and then also going home, we want them to be safe. We want them to be able to stay home. I've only ever worked in a hospital. We don't want you to have to be here, right? We're here when you need us, but we want you to be able to be healthy and be at home. And I think a lot of people can be healthy and stay home when we're taking the time, that extra step to make sure that you understand your chronic disease and how it's managed and how things may change and how it progresses and that it's one of these that is highly prevalent in my area. And a lot of that has to do with the genetics and pieces that are here. And I want people to understand that. And I want them to feel like we're taking care of you as a person. And I think that's one of the things that diabetes care and education specialists do really well. And I think it's one of the things that hospital administrators really strive for is that the people that we serve feel like we're taking care of them as a person along with taking care of their chronic diseases. For that part, I think that's a huge value that the diabetes care and education specialists can bring to working in the hospital.
Jodi
But how do you make sure that's communicated too? Because if they're filling out a patient satisfaction survey, they may not always say, “it's my diabetes care and education specialist that made the difference”. So, I'm just wondering how you make sure that those administrators know.
Chris
No, you're completely right. That's like my dream to have the “happy RN Daisy award” because of the care that I've given to someone with diabetes. I will say I have gotten a couple of outpatient satisfaction things I have, we get these big fish balloons. And so I actually do have a couple in my office from a couple of patients, which is wonderful. I think a lot of it comes when I have people like the hospitalist or my intensivist talking to my administration about how important having me as part of the care team is. I think these eCQMs are going to show a lot of that. It's still going to take a few years for all of that data and for mandated reporting. And I think it's important that my team, my outpatient team, my boss who is over our quality department, I think it's important for them to relay that information up the chain. I do try and build some relationships with our CNO, our chief nursing officer, I do build some relationships with the person who's over, our director over what we call Pathway. So it's like magnet, but not quite magnet with the hospital. And she's able to see the different parts that I bring, the things that I do in diabetes care in general.
Jodi
Yeah, you've told me in the past that you've had someone you talked with that was a doubter and that you would say what I can do for you to turn them around.
Chris
One of the teams that I work with a lot in our hospital is the cardiovascular surgery team. Lots of diabetes is heart disease and we really want to make sure that the outcomes for this big surgery are really helpful and good so our patients continue to live nice, healthy lives with that. Surgeons are a different breed and so they're real focused on their part of everything. So, diabetes is this side piece of it all. But I think over the years I have built, I know over the years I have built a trust, at least with our advanced practice practitioners who are part of that team, of how important the diabetes care is for these patients who are going through surgery and those outcomes afterwards. We're able to really come up with good plans and plans of action for all of this. This is a population that those continuous glucose monitors work great for too because diabetes likes to change after a big surgery.
So, I think we've moved away from some of these doubts that it's important to have the diabetes care and education specialist on board with this patient population. And that's been quite rewarding. I work really closely with both APPs that we have currently on that team to make sure that we're not forgetting about the diabetes, that we're helping that person with diabetes work through all of the surgery and all the changes that may come from there. I'm part of order sets because of that care. So any patient who comes to our acute rehab that has diabetes, it's an automatic. “Even if your diabetes is well managed or you're not taking any medications, we want to make sure you have that opportunity to talk with Chris”, kind of piece. I get to sit on our pharmacy and therapeutics committee, which is great. So I can have some input into like when we make an adjustment and formulary. We've been able to keep insulin pens at my hospital for a really long time because I'm still advocating for our nursing staff and how much better those can be for our nursing staff and then for our patients, because that's what they're using and learning how to use to give their medications as well. And the nice thing there is I get to sit with my chief medical officer. And so he gets to see the care that I give to people. And that's another kind of administrative piece of things too. It's like when you get to sit on those committees, they have those higher ups on the committees to really make the case for your value.
Jodi
Thank you, Chris, for sharing your experiences. While an inpatient diabetes care and education specialist doesn't necessarily face many of the same issues an outpatient DCES faces, you have some unique challenges and also some opportunities to impact care in a cost-effective way and ensure that your patients transition well and smoothly to the outpatient setting. So I think you've shared a lot of great ideas. You're talking about building relationships, showing what you can do, having a can-do attitude, being a resource, all those great things. So, thank you again.
Chris
Thank you for the opportunity to talk about my work as a diabetes care and education specialist. I've been in the hospital for 17 years. I really do think that we make a huge impact on the care that comes through the hospital system, especially when we're able to bring our knowledge base and our focus on that diabetes care and look at the person as a whole person and really bring that patient-centered care back home, which can sometimes feel like it gets lost a little bit in the hospital but the diabetes care and education specialist is well positioned to be able to bring that and enhance the value and the safe care in the hospital.
Jodi
Thank you for listening to this episode of The Huddle. If you want to learn more about how to effectively communicate the value of your services, check out our value toolkit created especially for ADCES members. You can find a link to the full kit in the show notes.
Remember that being an ADCES member gets you access to many resources, education, and networking opportunities, including our full value toolkit! Learn about the many benefits of ADCES membership at adces.org/join.
The information in this podcast is for informational purposes only and may not be appropriate or applicable for 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.