Inspired by insights gained at BWH, diabetes patient Harriet Ward carries a small wooden box everywhere. “I call it my pancreas,” she said. “It’s got everything I need — glucose monitor, syringes, insulin and a formula for counting carbohydrates.”
Afflicted with type 1 diabetes since childhood, this 52-year-old only recently managed to gain control of her blood sugars. She credits this achievement to the specialty care and teaching provided by Rita McCarthy, RNC, CDE, a diabetes nurse practitioner, and other clinicians in the outpatient Diabetes Management Service, headed by Ronald Arky, MD.
The Service’s educational strides were recently recognized when the BWH Section of Diabetes and Metabolism received American Diabetes Association Education Recognition for the third consecutive time. This recognition is granted for three years and promotes quality education for people with diabetes by ensuring that organizations adhere to the National Standards for Diabetes Self-Management Education.
Ward is among many patients who have benefited. “I met Rita only once,” she said. “That one-hour visit completely changed my life.”
A resident of Exeter, NH, Ward was referred to BWH after years of dealing with severe diabetes complications including near-death comas, retinopathy, cardiovascular problems, neuropathy, the onset of kidney failure, and amputation of her toes and a portion of her foot. “If I’d known my BWH team five years ago, I believe I’d have suffered fewer complications,” she said.
Rather than dwell on past problems, this teacher of visually impaired infants at the Perkins School for the Blind and occasional singer with the Tanglewood Festival Chorus, is upbeat about being equipped to face the future. “With a diabetes care system that works, I no longer lose heart,“ she said. “I check my blood sugar every time I eat to learn how my body handles various foods. For the first time in my life, I can keep my blood sugar in a normal range.”
Diabetes patients referred to BWH often arrive discouraged, scared or misinformed. “Diabetes requires a lot of work on the part of the patient,” said McCarthy. “But the patient can’t do that without the help of an expert care team.”
Strategies, such as carbohydrate counting in concert with regular glucose monitoring and different types of insulin, can make all the difference. Tailoring the program to the individual patient is key to success.
Obstetrics patient Erin Mahoney, a 33-year-old aerobics instructor, needed a crash course. Twenty-eight weeks into her first pregnancy, routine blood tests showed that she had developed gestational diabetes. After one week of trying to manage her blood sugar with diet and exercise, her BWH team also determined she needed insulin injections.
“I’ve gained a new respect for people with diabetes,” said Mahoney. She hopes her diabetes will disappear after the baby’s birth, but is thankful it was caught and managed well. “BWH gave me the right tools and made me feel it’s all about me and the baby.”
Personalized diabetes care is the focus of several new inpatient and outpatient efforts at BWH. On the General Medical Service in Tower 14, Nurse Manager Patty Brita Rossi, RN, MS, has identified four nurses the clinical staff can call upon to consult with patients who need to learn more about self-care of diabetes, which often is part of a complex array of disorders. In these one-hour sessions, the teaching nurse explains how to integrate glucose monitoring, medications, exercise and an eating plan to better control blood sugar. Nurses identified for this role include Beth Baldwin, RN, Kristen Brodeur, RN, Suzanne Ridlon, RN, and Thomas Wright, RN.
On the Surgical Service, a team of physicians and nurses work together to manage the clinical care of patients with diabetes and prepare them for discharge. Nurse practitioners involved in this program are Deborah Homer, RNC, ACNP, and Leslie Griffin, RNC, ACNP. Many patients are intimidated by finger sticks or perplexed by glucose monitors. Thanks to a no-cost program arranged by Pharmacy Services Director Bill Churchill, MS, RPh, with a monitor manufacturer, BWH inpatients can practice with a monitor during hospitalization, then take it home with a starter supply of strips. Patients who need insulin also get a learning kit that contains a starter supply of syringes.
After discharge, follow-up calls and visits help cement and expand understanding. Patients also are encouraged to return to BWH for a diabetes class, held at the Kessler Health Education Library in the Bretholtz Center every Wednesday from 8:30 to 10 a.m. This class is staffed and supported by the nurses on the General Medical Service.
At the outpatient clinic of Brigham Internal Medicine Associates, diabetes teaching is overseen by several nurse practitioners and Diabetes Educator Monica Hynes-Payack, RN, MS. “With each visit, we ask what they are eating and help them focus on ways to better control their diabetes,” she said. “We strive for incremental improvement, making adjustments for out-of-control diabetes or fine-tuning care if they’re doing well.”
To support these efforts, the Health Promotion and Education Program at BWH, directed by Laura Rossi, RN, MS, recently compiled a patient information packet on diabetes. The folder contains a 30-page guidebook, recipes for healthful eating, foot care tips, lists of specialty services at BWH, resources available in BWH’s Kessler Library, and helpful phone numbers and Web sites.
Living more than 50 miles from Boston, patient Harriet Ward especially appreciates BWH’s long-distance services, which allow her to send her glucose results via e-mail. “I’ve never had so much attention in all my life,” she said, crediting her endocrinologists Annaswamy Raji, MD and Hylton Joffe, MD. “Diabetes patients have a lot to figure out themselves, but BWH gives you the tools to be intelligent.”
For more information on the weekly diabetes class, check www.brighamandwomens.org/healtheducation
The patient package is also available through the Standard Register’s Office at BWH (ext. 2-8700).