The Role of the Licensed Practical Nurse (LPN) and Medical Assistant (MA) in Improving Outcomes in Diabetes Care

Background: 30 million Americans have diabetes, with an additional 84 million suffering from pre-diabetes. These patients demonstrate a significantly increased risk for heart disease, stroke, renal failure, blindness, and impaired peripheral circulation and neuropathy (CDC.gov, 2019). In the ongoing effort to improve health outcomes while reducing inefficiencies in ambulatory care, this organization has developed a diabetes health professional program (DHPP) to standardize the mechanism for providing patients with the education necessary to prevent progression of the consequences of diabetes without increasing staffing cost.

Methods: The American Association of Diabetes Educators (AADE) offers an online, self-paced diabetes paraprofessional program that provides an advanced body of core knowledge and skills related to diabetes education and management that is geared towards health care professionals. This program was utilized as a basis for the DHPP in this organization. Clinical staff (MAs and LPNs) were nominated by managers to enroll in the program. Care was taken to ensure that nominations were spread across many of the ambulatory care offices to ensure a standardized approach to diabetic education for patients and families across the organization. The DHPP is run by a registered nurse (RN) clinical educator who oversees the students, providing additional mentoring and tutoring as needed as the students learn the material. Once the students complete the program, their successes are celebrated and they immediately begin their work. They choose a taskforce (2019 taskforces include eye exam; foot care; importance of hemoglobin A1C (HA1C); importance of micro-albumin testing; and monitoring blood pressure, nutrition and blood sugars) and work together to develop educational materials and forums for their co-workers, patients, and family members. Materials may include huddle talking points, flyers and bulletin boards for the offices, pamphlets, and short videos for staff and/or patients, etc. The RN clinical educator remains a mentor and works with a dyad physician champion partner; together they provide guidance and final approval on all teaching points, materials, and forums.

Results/outcomes: The major metric for this program is the organizational diabetes bundle compliance score. YTD the score is above target at 78.22 (up from 2018 close of 77.33). Additionally, this program is designed to positively impact employee engagement and patient experience.

Implications for practice: The developed curriculum incorporates chart prep, patient communications, rooming practices, and office staff communications to provide standardized education across ambulatory care setting. This DHPP drives quality outcomes, fosters a positive environment that promotes engagement and professional development among staff, and empowers patients living with diabetes the knowledge required to achieve optimal health outcomes. The cost of the program is about $200 and is covered by many organizations’ continuing education benefit. On average, the program takes two about months to complete with a majority of the work being completed by the students at home.

Reference
1. CDC.gov. (2019). Division of diabetes translation at a glance. Retrieved from https://www.cdc.gov/chronicdisease/resources/publications/aag/diabetes.htm