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Keywords: Managing diabetes is more than testing Medline makes it easy Improving Diabetes Management in Long-Term Care Diabetes is a devastating disease that greatly impacts long-term care. Twenty-six percent of nursing home residents have diabetes. The estimated cost of caring for these residents, and the complications arising from diabetes, exceeds $6 billion dollars annually. In the United Sates, approximately $132 billion dollars goes towards the cost of diabetes and its complications. Considering that heart disease, stroke, high blood pressure, blindness, kidney disease, dental disease, nervous system disease, and even amputations are all complications of diabetes, it’s easy to see why healthcare providers want to do everything they can for their residents. Diabetes is the 6th leading cause of death and 82,000 lower limb amputations are performed annually. Additionally, knowing that CMS is looking at Pay for Performance measures and considering avoidable hospital admissions, like those due to complications from diabetes, it is vital for nursing home staff to understand current standards of practice. Managing diabetes is more than glucose testing. Recognizing this, Medline has assembled a tool to help healthcare providers provide better care for residents with diabetes. We compiled and organized data acquired during the course of working with healthcare professionals for more than 40 years. Our Compass Diabetes Program includes a main binder for the Director of Nursing and supplemental educational packets to be placed on carts for daily reference. Compass will help staff care for residents with diabetes and provide education and training materials for staff and family members. ADA Standards of Care The American Diabetes Association (ADA) is the nation’s leading voluntary health organization supporting diabetes research, information and advocacy. Their mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Special tests and exams are critical to diabetes care. The ADA guidelines are as follows: Test or Exam Frequency Routine physical exam Once a year Blood pressure At every routine exam Lipid (cholesterol) test Yearly, if low risk, every 2 years Comprehensive foot exam Yearly, including sensory (nerve) test Eye exam • Yearly, by an eye physician (ophthalmologist) • For Type 1 diabetes, start the yearly exams within 3-5 years of diagnosis • For type 2 diabetes, start now Microalbumin (protein) urine test • Yearly, For Type 1 diabetes, start testing 5 years after diagnosis • For Type 2 diabetes, start now Hemoglobin A1C (HbA1c) Every 3 to 6 months What’s in the Compass Diabetes box? • One Director of Nursing (DON) Instruction Manual— A teacher’s guide to the program, which includes 4 CE contact hours. • Three additional Glucose MonitoringTraining resource books— Put them on treatment carts or in nurses’ stations for easy access. • Five additional Family Education books—Give them to residents’ families. • Two Educational Compact Discs (CDs)— To educate staff on using the Optium™ Glucose Monitoring System. 1 Nutrition Healthy nutritional habits help control diabetes and reduce risk factors for other complications such as heart disease, kidney disease, and vision-related issues. To get the correct amount of vitamins and minerals and remain energetic, it is best to eat a variety of foods. The Compass Diabetes Program lists food sources where these vitamins and minerals can be found. While adequate oral intake through meals and snacks is always desired, there are times when supplements are necessary. Nutritional supplements help add important nutrients to a resident’s diet, and can be helpful in situations where residents are unable to eat enough food to meet their individual nutritional requirements. The following four key elements should be focused upon to provide the best possible care for residents with diabetes. STAYING HEALTHY Glucose Monitoring Residents diagnosed with diabetes need to have their blood sugar levels tested daily or as ordered by their physician. Regardless of the monitor chosen, it is imperative that it be used correctly because appropriate care can only be provided based on accurate test results. There are many variables that can affect glucose readings. Results can be affected by medications, sample size, and how the test strips are packaged. Our Compass Diabetes Program provides valuable information about glucose testing. Medline’s Optium monitor,manufactured by Abbott Diabetes Care, takes these factors into account by utilizing its patented True MeasureTechnology. Optium's test results are not affected by commonly taken medications, which permits the health care professional to apply an additional sample onto the same test strip. The individually wrapped foil test strips ensure that the test strip was not compromised by humidity, dust, dirt, consideration and produces a glucose-specific result. To compliment daily glucose testing,ADA guidelines indicate that a Hemoglobin A1C test should be performed every 90 days. A1C testing measures the average glucose levels for a 2 to 3 month span of time. This result allows the physician to gauge if the resident is on an appropriate combination of medication to control glucose. An elevated result indicates poor glucose control. If glucose levels remain elevated, the risk of developing complications is increased. 2 Exercise Exercise is an effective way to improve physical health. While fitness is promoted primarily to the young, research indicates that the elderly can also benefit from an exercise program. Many nursing facilities have developed creative health and fitness programs to improve their resident’s physical and emotional health, and they are especially effective to help manage diabetes. Our Compass Diabetes Program details sample exercises that can be done by residents even if they are wheelchair-bound. Medication Different medications are regularly used to treat diabetes. Type 1 diabetes is usually treated with insulin administered by injection or through a pump. Individuals withType 2 diabetes, depending on their physician’s orders, generally control their diabetes through a combination of dietary modification, exercise, oral antidiabetic medication, or some form of replacement insulin. Our Compass Diabetes Program provides education on medication and its role in treating diabetes. 3 Pathogens are infectious materials that cause disease in humans. Many pathogens are blood borne. Universal precautions should be followed to help protect from spreading infectious disease. There are more than 20 infections that can be transmitted through needlesticks, including: hepatitis C, HIV, hepatitis B, tuberculosis, syphilis,malaria and herpes. The Needlestick Safety and Prevention Act passed by Congress became effective April 18, 2001. In response,OSHA revised the Bloodborne Pathogens Standard. The revised standard clarifies the need for employers to select safer needle devices and to involve employees in identifying and choosing these devices. The updated standard also requires employers to maintain a log of injuries from contaminated sharps. All medical facilities must evaluate, select and implement safer sharps safety devices including needles, syringes and devices designed to eliminate or minimize occupational exposure. Safety devices help reduce the likelihood of needlestick injuries before, during and after use through built-in safety features. No single device will work equally well in every circumstance. Employers must develop programs to select the most appropriate devices. Ultimately, the device must be clinically effective, acceptable to users, and it must reduce needlesticks. Sample page of Safety Self-Assessment LetMedline be part of your survey-preparedness team. YourMedline representative can provide you a copy of the Safety Self-Assessment, or you can contact us through www.medline.com. The second section of the booklet consists of Medline product solutions that can help you comply with various safety requirements. Choosing the right product for your specific situation can increase the safety of your employees and residents. ADDRESSING SAFETY COMPLIANCE 4 Medline Optium™ Glucose Monitoring System Medline Optium test strips are designed to prevent inaccurate tests and test strip wastage caused by interferences from many common substances and/or application of an inadequate sample volume. Application of inadequate blood samples in some blood glucose monitoring systems can potentially lead to erroneous results or error messages, which mean wasted test strips. A unique fill trigger prevents the test from starting until an adequate blood sample is applied. Simply add more sample and the Medline Optium meter produces a result, without compromising accuracy. With a 450 result memory, downloading feature and large, easy-to-read display, the Optium system can handle all your blood glucose testing needs. Item No. Description Quantity MIS70517Z Optium Blood Glucose Meter 1 ea MIS99134 Optium Glucose Test Strips 12 bx/cs 50 ea/bx MIS99134Z Optium Glucose Test Strips 50 ea/bx MIS99135 Optium Glucose Test Strips 6 bx/cs 100 ea/bx MIS99135Z Optium Glucose Test Strips 100 ea/bx MIS70550 Precision Control Solution 6 bx/cs 1 vial high, 1 vial low per box MIS70550Z Precision Control Solution 1 set/bx 1 vial high, 1 vial low per box Monofilament This monofilament can be used as a routine test to assess a resident’s foot sensitivity. Item No. Description Quantity MSC0002 Foot Monofilament, Diabetic Neuropathy Test 25/bx A1C Test The A1CNow® InView System offers incredibly fast, quantitative A1C results (in just 5 minutes) utilizing micro-optical technology that is integrated into a proprietary reusable monitor with single use cartridges that is lab accurate at 99%. Item No. Description Quantity DIB0310510 A1cNow InView Monitor 10/kit Medline Preferred Safety Lancets (available July, 2007) Medline Preferred safety lancets are simple and safe for both the healthcare professional and the patient. The needle retracts automatically and locks out for extra safety, protecting patients and healthcare professionals from needlestick injuries and preventing cross-contamination. Item No. Description Quantity MPHSAFETY21 Lancet, Normal Flow, 21 Gauge 1.8mm 200/bx MPHSAFETY28 Lancet, Micro Flow, 28 Gauge 1.6mm 200/bx MIS70517Z MSC0002 DIB0310510 MPHSAFETY28 5 Safety Lancets Offers maximum comfort for your residents. The Unistik® needlepoint is hidden before use and automatically retracts after use to avoid needle stick injuries and cross contamination. Item No. Description Quantity OMMAT0747Z Unistik 2 - Comfort 28 Gauge 1.8mm depth penetration 200/bx OMMAT0704Z Unistik 2 - 21 Gauge 2.4mm depth penetration 200/bx OMMAT0714Z Unistik 2 - 21 Gauge 3.0mm depth penetration 200/bx Safety Insulin Syringes These safety syringes have a secure safety shield that covers the entire needle length. Item No. Description Quantity SWD511110Z 1 mL syringe, 29 gauge x 1/2” needle 100/bx SWD511136Z 1/2 mL syringe, 29 gauge x 1/2” needle 100/bx SWD511144Z 3/10 mL syringe, 29 gauge x 1/2” needle 100/bx SWD511310 1 mL syringe, 30 gauge x 5/16” needle 500/cs SWD511336 1/2 mL syringe, 30 gauge x 5/16” needle 500/cs SWD511344 3/10 mL syringe, 30 gauge x 5/16” needle 500/cs Woven Gauze Sponges Ideal for wound dressing, our gauze sponges have folded edges to prevent unraveling and are debris-free when packaged. Sterile 2’s are packed in coated paper envelopes to further reduce fiber debris. Easy-open packages. Item No. Description Quantity NON21420 2" x 2", 8-ply, sterile 50 pk/bx 30 bx/cs 1,500 pk/cs Alcohol Prep Pads Before injections, alcohol prep pads are used as a topical antiseptic. The soft, absorbent, non-woven pads are saturated with 70 percent isopropyl alcohol, USP. Item No. Description Quantity MDS090730 11⁄4" x 21⁄2", medium 200/bx 3000/cs SWD511110Z OMMAT07 series MDS090730 NON21420 6 Oral Supplements Item No. Description Quantity DOY349100 Resource® Diabetishield®, 27 tetra 8oz Orange Burst brik/cs DOY349300 Resource Diabetishield, 27 tetra 8ozWild Berry brik/cs DOY360100 Boost® Diabetic, 27 tetra 8oz Vanilla brik/cs DOY360200 BoostDiabetic, 27 tetra 8oz Chocolate brik/cs DOY360300 Boost Diabetic, 27 tetra 8oz Strawberry brik/cs Tube Feeding Formulas Item No. Description Quantity DOY355001 Resource® Diabetic TF, 1000mL 6 btls/cs DOY355020 Resource Diabetic TF, 1500mL 6 btls/cs DOY365000 Diabetisource® AC, 250mL 24 cans/cs DOY365001 Diabetisource AC, 1000mL 6 btls/cs DOY365020 Diabetisource AC, 1500mL 6 btls/cs Medline Active Protein Item No. Description Quantity Medline Active Protein is a flavor-free way to add a high-quality whey protein isolate. We offer a highly dispersible supplement for residents who need more protein in their diet. It can be added to all types of foods or beverages. Active Protein contains 6g of protein per serving and is a high-quality, lactose-free source of concentrated protein with a well-balanced amino acid profile. ENT32108 Medline Active Protein, 8 oz Can 6/cs Resource Arginaid® Item No. Description Quantity Resource Arginaid drink mix is an arginine-intensive drink formulated for patients recovering from burns, surgery, or chronic wounds. This drink contains nutrients that may help to promote healing. This product is intended for pressure ulcers, diabetic ulcers, venuous ulcers and burn injury. DOY359830 9.2g (0.3 oz) Packets Orange 56/cs DOY359840 9.2g (0.3 oz) Packets Cherry 56/cs DOY359850 9.2g (0.3 oz) Packets lemon 56/cs (4 inner cartons, 14 packets each) DOY365000, DOY365020, DOY365001 DOY355020, DOY355001 ENT32108 DOY360100 7 DOY349100, DOY349300 Over the Counter Drugs Item No. Description Quantity OTC25233 Glucoburst™, Glucose Gel, 15 g/Pack. Caffeine Free & Paraben Free 3 packs/bx OTC9L75504 Tussin DM, 4 oz. Bottle, Sugar Free, Alcohol Free, Dye Free 1 btl OTC83101 Vitamin C 250Mg Tablets 100/btl OTCS0783C2 Vitamin C Chewable 250Mg 100/btl OTC84101 Vitamin C 500Mg Tablets 100/btl OTC027760 Vitamin E 1000IU Soft Gels 100/btl OTC0047982 Vitamin E 200IU Soft Gels 100/btl OTCS0813C2 Vitamin E 400IU Soft Gels 100/btl OTC0047996 Vitamin E 400IU Soft Gels 1000/btl Lotions Item No. Description Quantity A risk factor of Diabetes is dry skin and bacterial infections of the skin. Since the skin is an actively metabolizing system and relies on the cardiovascular and nervous system, diabetes affects the skin indirectly. The importance of a skin care regiment is essential. Medline has a variety of lotions to aid to this process OTC060001 Hydrocerin Cream 16 oz Jar, compare to Eucerin 56/cs OTC062008 Hydrocerin Lotion 8 oz Btl, compare to Eucerin 56/cs OTC81008 Lubriskin Lotion 8 oz Btl, compare to Lubriderm 56/cs Patient Room Sharps Containers System of sharps disposal containers designed for use in patient rooms and high traffic areas. • Tortuous lid design limits access to container contents. • Lid design facilitates one-handed operation. • Horizontal drop design for maximum capacity to fill line. • Translucent lid provides easy-to-see fill levels. • Containers easily lock for final disposal and safe transport. • Large openings accommodate larger syringes. • Nestable design saves money in shipping costs and storage space. • Multiple bracketing options. Item No. Size Feature Quantity MDS705125 2.5 Quart Wall Mount 30 ea. MDS705152 5 Quart Wall Mount 30 ea. The most popular patient room product. MDS705151 5 Quart Wall Mount/Freestand 14 ea. MDS705203 3 gallon Wall Mount/Freestand 12 ea. OTC9L75504 OTC25233 OTC84101 MDS705203 MDS705151 MDS705152 8 Multipurpose Sharps Containers Every area has its own unique sharps disposal needs. These containers are designed for use in restricted access areas. • Non-tortuous lid design accommodates a variety of sizes of sharps. • Translucent lid for quick ID of fill level. • Containers lock for final disposal. • Nestable containers save space and reduce shipping costs. • Horizontal drop maximizes use of container volume. • Brackets available. Item No. Size Quantity MDS705201 1 gallon 32 ea. MDS705202 2 gallon 20 ea. The most popular multipurpose product. Phlebotomy Sharps Containers Portable sharps containers are designed to fit into blood drawing trays, also provides point-of-use disposal and features a square base for added stability. • Translucent top allows easy ID of contents. • Choice of single or dual openings accommodates a variety of sharps. • Containers lock for final disposal and safe transport. • Available holders and brackets. 1 Quart Containers Item No. Size Quantity MDS705110 1 Quart 100 ea. The most popular phlebotomy product. 1.5 Quart Containers • Funneled opening with snap-type closure. • Designed to fit Artrocarts. Item No. Size Quantity MDS705115 1.5 Quart 20 ea. Mail-Back Sharps Containers Each Kit includes all components required for collection and transportation of sharps and regulated medical waste. • Compact design that uses a minimum of counter space. • Lids that provide temporary and final locking closure. • The most available sizes in the industry. • Step-by-step instructions. •Waste shipping containters. • Easy to use and close outer shipping box. • Pre-paid, pre-addressed shipping labels and Pre-paid disposal. • Tracking documents. Item No. Size Quantity SCC1QV2 1 quart 1 ea. MDS705000 1 gallon 1 ea. SCC2GV2 2 gallon 1 ea. SCC3GV2 3 gallon 1 ea. SCC5GV2 5 gallon 1 ea. MDS705202 MDS705201 MDS705115 Sharps Container - MDS705110 plastic Holder - MDS707910 sold separately 9 Brackets and Cabinets for Sharps Containers Mounted wall cabinets secure sharps containers, free up counter space and help prevent access in high-traffic areas. Economical wall mounting brackets provide an unobtrusive method for mounting containers. Easy to clean and suitable for a variety of decors. • Containers secured in locked enclosure. • Cabinets feature a tinted viewing window that allows contents to be viewed by hospital personnel, but not by others. Item No. Description Quantity MDS707054 Wire bracket, locking, for MDS705151 & MDS705203 10 ea. MDS707062 Wire bracket for MDS705151 and MDS705203 10 ea. MDS707963 Wire bracket, locking, for MDS705201, MDS705202 & MDS706202 5 ea. MDS707975 Wire bracket for MDS705201, MDS705202 &MDS706202 5 ea. MDS707912 Wire bracket for MDS705110 5 ea. KDL8518X Wire bracket, locking, for SWD85121 and SWD85131 5 ea. KDL8519C Wire bracket for SWD85121 and SWD85131 5 ea. MDS707960 Plastic bracket for MDS705125 and MDS705152 (includes 5 keys) 20 ea. KDL31139747 Replacement Key for MDS707960 10 ea. MDS707549 Wall cabinet with key for MDS705125 & MDS707152 10 ea. MDS707553 Wall cabinet with key for MDS705151 1 ea. MDS707005 Wall cabinet with key for MDS705203 1 ea. KDL85165H Wall cabinet with key for SWD85121 and SWD85131 5 ea. Locking Cabinet Refills Sharps container fits into some Sage and Kendall locking cabinets. Item No. Size Quantity SWD85121 Clear, 5 qt. 20 ea. SWD85131 Red, 5 qt. 20 ea. MDS707960 Sources 1. Nursing Homes Long Term Care Management. www.nursinghomesmagazine.com. Accessed April 11, 2007. 2. American Diabetes Association. Available at www.diabetes.org. Accessed April 30, 2007. 3. American Diabetes Association. Available at www.diabetes.org. Accessed April 30, 2007. A1cNow is a registered trademark of Metrika, Inc. Boost Diabetic, Diabetisource AC, Resource Arginaid, Resource Diabetic TF, and Resource Diabetishield are either registered trademarks or trademarks of Novartis AG Corporation, Switzerland GlucoBurst Glucose Gel is a trademark of PBM Products, LLC. Optium is a trademark of Abbott Laboratories, Inc. Unistik is a registered trademark of Owen Mumford, Inc. MDS707912 MDS707553 (Container shown, sold separately) MDS707549 MDS707005 (Container shown, sold separately) SWD85131 (Cabinet not included) 10 Not all products are currently available for sale in Canada. Please contact your Account Representative for additional information. For your convenience we have included a CD that includes diabetes related product brochures as well as educational information for you and your staff. We hope that you find its contents helpful in developing a care plan for your residents with diabetes. MKT207053/LIT196R/10M/4xxx
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