Home Health OASIS Nursing Assessment for Diabetes

Diabetes is a condition, which poorly maintained can lead to serious complications, such as, arteriopathy, retinopathy, nephropathy, and neuropathy. Poorly controlled blood sugars over a period of time can significantly impact an individual’s health, resulting in compromised vision that can be as severe as total blindness and chronic kidney disease that can progress to dialysis dependency. Also, neuropathy in these individuals can present with some tingling and numbness in the extremities and progress to poor sensitivity to touch and temperature changes, which can result in poor realization to risk for skin integrity and wounds on the distal extremities. Compromised blood supply to the distal extremities in these individuals can contribute further to the damage, making the wounds delayed or non-healing. Progressive deterioration of wounds can result in complications, such as, sepsis, infection of the underlying bone also known as osteomyelitis and necrosis of tissue, leading to amputation on the extremities.

These crippling complications with diabetes significantly impact an individual’s independence with managing their lifestyle, thus making one increasingly caregiver dependent. They also influence one’s mental and psychological health, the ramifications of which are felt far beyond. The goal of home health is to educate the patients and caregivers regarding the complications that can arise out of poor management of the patient’s diabetic state, help prevent complications, and thereby promote patient’s independence to the extent possible.

In this blog, we primarily discuss home health OASIS Start of Care assessment and Weekly Visit notes documentation requirements for blood sugar control in diabetic patients.

Start of Care Assessment Documentation

Blood Sugar Control

• Check for the duration one has been a diabetic. They don’t have to be precise but just an idea to be sure if it has been a chronic complaint or if one has newly turned diabetic.
• Check with the patient or caregiver on the patient’s current blood sugar control. Check for availability of any recent HbA1c value.
• Add notes on any recent medication or dose changes made to adjust the numbers to safe parameters.

 

Documentation for the Weekly Visit Notes

Blood Sugar Control

• On all the weekly visits, check for any progressive signs and symptoms of poor blood sugar control, such as, frequent urination, nervousness, irritability, frequent headaches, hunger, increased thirst, dry mouth, unintentional weight loss, confusion, dizziness, fatigue, and episodes of loss of consciousness.
• Enquire into experience of these symptoms during the week, if any. Determine the possible reasons contributing to poor blood sugar control, such as, poor compliance with dietary patterns, practicing inappropriate eating schedules, noncompliance with recommended calorie & other dietary limitations, poor compliance with recommended medication intake, and so on.
• This can help with incorporating appropriate management measures and patient education information on your weekly visits.
• With patients in assisted living facilities, memory care units, and group homes, you can check with the facility staff or the nurse station during your weekly visits and obtain a copy of the numbers during the week.

 

Poor Blood Sugar Control During the Visit

• During your visit, if the numbers were poorly controlled, check if the patient has been compliant with meal and recommended medication intake for that time of the day.
• It is common to find patients forgetting to take their medication and irregular with diet intake. For individuals noncompliant with medication intake, go ahead and allow the patient to take their scheduled medication. If the numbers were too low, offer the patient a snack and allow numbers to settle.
• If the numbers were high despite scheduled medication intake, check for any persisting signs and symptoms of hyperglycemia, to exclude any safety concerns after you leave – especially if the patient were living alone. We should always make sure the patient is safe before we leave.
• In either case, numbers high or low, report the incident to the physician’s office and the caregiver.
• Check with your manager on the agency protocol in this situation. After 30-45 minutes, go for a second reading of the numbers. Make sure the numbers are in safe zone before you leave. Do not forget to document the detail on your visit note.
• If the numbers are grossly out of safe parameters, recommend an ER visit to promote patient safety.
• Instruct the patient and caregiver to follow closely on signs and symptoms of poor blood sugar control to be alerted to.
• Also, starting the patient on continuous blood glucose monitor with caregiver access for monitoring the numbers can significantly help to avoid such dangerous highs and lows on blood glucose readings.

 

Patient Education for Patients with Diabetes

Though diabetes has a wide-ranging devastating effect on an individual’s overall health, it is still a very well manageable health condition with proper patient education, timely clinician intervention, and commitment on both ends.

Providing the patient and caregivers with proper education on disease process and complications is an essential element of clinician’s responsibility towards management of diabetes.

Some of the topics that the patient and caregiver education could include but not limited to are

• Food groups and calorie count
• Meal planning and counting carbohydrates
• Healthy blood sugar ranges for fasting, random, and post-prandial readings
• Signs and symptoms of hypoglycemia and hyperglycemia, finding to watch for and report
• Signs and symptoms of acute complications, such as, diabetic ketoacidosis and findings to watch for & report
• Managing high and low blood sugar readings at home
• Findings to be alerted to and call for help
• Role of healthy weight management for blood sugar control
• Role of physical exercise and stress management in diabetes control
• Compliance with self-monitoring and log maintenance of blood sugar numbers
• Medications, side-effects, and precautions to be taken, as applicable
• Insulin administration, site rotation, and skin care as applicable
• Training patient on insulin pump, as applicable
• Long-term complications with poor blood sugar control, such as, diabetic retinopathy, arteriopathy, neuropathy, nephropathy, renal failure, findings to watch for and report.
• Regular foot inspection and periodical toenail care
• Compliance with periodical vision exam and podiatrist visits