Professional education in a long-term-care facility: program development in diabetes

To effect diabetes care in a 1000-bed chronic care institution, a program development approach to multidisciplinary staff education was implemented. Chart audit, staff interviews, and observations were used to evaluate care standards. Initial assessment revealed that none of the charts included a thorough evaluation of patients for skills, knowledge, and adherence related to care of diabetes. Additionally, it was found that the current diagnostic criteria for diabetes and urine testing procedures were not being used. An educational approach was implemented to teach current information about diabetes, to focus on multidisciplinary coordination of care, and to set goals for care on model care units. Postintervention assessments of the model care units were completed at 6 and 24 mo. There were substantial alterations in care, with more of the charts meeting the standard in each of the eight categories under investigation: diabetes diagnosis according to National Diabetes Data Group criteria, urine testing, capillary blood testing, rotation of insulin injection site, assessment of patients for adherence to regimen, assessment of patient skills and knowledge, and interdisciplinary coordination of care.