Twice a day for the last two months, Ed Westdorf, 75, has had visits to his Courtenay home from a Community Health Services nurse. On this day, it’s Melanie Yu’s turn to check Ed’s current insulin orders and blood glucose levels, and record how he is doing. Ed receives an insulin injection from Melanie, and then he carries on with his day and with independent living.
“It’s great having this service at home,” says Ed. “My blood sugar levels have come way down.”
In Comox, Campbell River and Port Alberni, the fact that Ed and clients like him are now able to receive their daily insulin injection in their own home, when they can no longer inject themselves due to dexterity issues or cognition, means that they are no longer likely to need long-term care just to manage their diabetes.
This improvement to the quality of patient care came about through collaboration between Community Health Services and Community Virtual Care, with help from experts in risk management, IHealth, pharmacy, medication safety, professional practice, device management and health information management. Together, they created a tool for documentation in the electronic health record that is a “first” in community health services: allowing a nurse to visit daily and use the client’s electronic health record to view current medical orders, document and administer a safe dose of insulin.
Diabetes management: a growing health care concern
Diabetes is a growing concern in Canada, with approximately nine per cent of Canadians living with this chronic condition, according to the Canadian Chronic Disease Surveillance System (CCDSS). While new treatments such as insulin monitors and pumps have made living with the disease easier for many Canadians, not all people are good candidates for this technology. Some people, due to dexterity or cognitive issues, still depend on a daily injection, administered by a nurse. And while in some parts of Vancouver Island, private pharmacies have been providing daily insulin for years, until now the service has been restricted to those who live in certain areas and who meet the private pharmacy eligibility criteria. Community Health Services is working toward establishing the diabetes insulin management service across the island for those clients who are struggling, supporting them to live at home longer.
Developing a safe solution for administering insulin
Unlike at private pharmacies, public health authorities must coordinate work across a number of departments so that they all have the same access to vital patient information. At Island Health, developing the in-home service involved at least seven departments. Community physicians prescribe insulin to patients; retail pharmacists prepare the dosage; the Community Resource Team provides nursing education; a virtual diabetic nurse educator (DNE) at Community Virtual Care provides consults for complex clients, liaises with community physicians as needed and provides in the moment practice support to Home Care Nurses; a CHS pharmacist initiates the treatment plan with the physician and lends support to the nurses; Home Care nurses deliver the service; and Cerner Operations and IHealth project staff have been developing the digital documentation needed to support the program.
At the heart of this service is the electronic health record (EHR) and an organizational change initiative called IHealth. It has as its goal: “One person. One record. One plan for health and care”. IHealth focuses on improvements in quality, consistency and standardization of care across services and throughout the lifetime of every patient. It also involves the shift from paper documentation in many health “silos” to one electronic record that can be accessed by all parties involved in the care of a patient.
Sarah Westgate, Regional Manager for Community Health Services – Home Care Strategy at Island Health, says that by using the EHR, “Primary care providers can look in [to the patient’s health record] and see what is going on.” So can the DNE working virtually to support home care nurses with complex patients, and the CHS nurses attending patients at home.
Julia Wilson, Project Director of Community Health and Long Term Care at Island Health’s Enterprise Project Management Office, is grateful for the teamwork shown by her colleagues as they designed the new service. “It took collaboration between different departments and getting the right stakeholders together, then having a vision to get to the outcome.”
That outcome has paved the way for this new standardized diabetes insulin management service within Community Health Services, and for future innovation related to viewing medication administration records in a single place. Island Health will build on this success as it continues to use the electronic health record to improve care quality in ways that support people living at home.
The insulin service currently being provided in Comox, Campbell River, and Port Alberni will be rolled out to the rest of Island Health in stages. Mount Waddington and Oceanside will go live in Feb 2023, then communities across the island will follow in 2023-24.
For now, the new service helps Ed Westdorf and dozens of other people like him continue to live independently while getting the support they need to help manage their insulin safely and reliably – at the same time keeping hospital spaces free for those who need them urgently.