Do you use innovative approaches to achieve efficiencies? Please send them to us so that we can keep the information-sharing going in future issues:
When it comes to diabetes education and training—and healthcare in general—it’s true today more than ever that everyone is being asked to do more with less. The best way to embrace that challenge is to develop efficiencies that save time and resources while still delivering high-quality patient care.

We’ve brought together 3 diabetes educator (DE) thought leaders to tackle the topic of practice efficiency—especially for pump therapy training and education. Their advice ranges from holding group training classes to fully utilizing Medtronic Diabetes’ clinical team to lighten your load.

The insights and best practices come from:

    HEATHER LECLERC, MS, RD, CDE: Heather is a clinical supervisor of The Diabetes and Endocrine Specialists of Maine, an outpatient practice of Eastern Maine Medical Center, where she has worked for the past 28 years. Along with the office’s 5 other certified diabetes educators (CDEs), she provides education for patients with diabetes of all ages and assists the 5 providers in the office with day-to-day medical management. Approximately 8 years ago, Heather developed latent autoimmune diabetes in adults (LADA) and is treating it with the MiniMed® 530G with Enlite®.
    GENEVA KENNEDY: Geneva is a certified product trainer (CPT) for Medtronic, based in Kentucky. For the past 11 years, she has worked collaboratively with the medical team at a large endocrinology practice. Her work for Medtronic includes helping to identify patients with T1D and type 2 diabetes (T2D) who are candidates for pump therapy, and providing support for insurance processes, pre-pump training, pump therapy initiation, and ongoing training.
    LAUREL MESSER, RN, MPH, CDE: Laurel is a proud diabetes educator and clinical research nurse who has specialized for the past 10 years in type 1 diabetes (T1D), insulin pump, continuous glucose monitoring (CGM), and artificial pancreas device system studies. She works with pediatric and adult patients at the Barbara Davis Center for Childhood Diabetes in Aurora, Colo. Laurel helped author the Pump and CGM Pink Panther book and has contributed to others in the series.

Q: What are some of the ways in which you have created efficient training processes for patients who are starting pump therapy?

“We do most of our insulin pump training in small groups, with sessions taking place every few weeks. Once we know patients are moving to pump therapy, we get them on the list for a training session. Once they have their pump in hand, they call the office and we get them scheduled for the next training class.

The group format allows us to provide really comprehensive education, since it’s more efficient than providing the same education to 1 patient at a time. We helped break new ground in the state of Maine by offering pump training in a group format.

Also, for patients who have been on the sensor for about a month, we just recently began offering group training where we focus on sensor best practices, Q&As, and practical information such as insertion advice and taping tips. Our Medtronic Diabetes clinical liaison noticed that many patients were asking questions about the sensor, and she suggested that we offer these classes. She even provided us with [information on available] billing codes we can use for these group education appointments, so that the time invest results in a revenue stream for the practice.

Being able to see more patients in the schedule and offer them high-quality training in the same amount of time is about as efficient as it gets.”

-Heather Leclerc, MS, RD, CDE

“I know that I am a more effective trainer when I have my own training rhythm down. When I learn a new training, I spend time carefully reviewing the training material and highlighting the key points I want to emphasize. I also paperclip pages together so I turn to only the most important material first when working with patients.

I utilize Medtronic’s printed material in this manner. You should see my 'Getting Started' guides for the MiniMed® 530G insulin pump and the system’s CGM—highlights, paperclips, dog ears, and notes. This helps me stay focused on what’s most important when in the actual training, making appointments much more efficient and productive.”

-Laurel Messer, RN, MPH, CDE

“Patient engagement is essential in setting the stage for efficient and effective pump training. In my experience, ensuring that patient comfort levels are high helps shorten learning curves and increases recall, which positions patients for success.

My goal as a CPT is to support not only the patients, but also the providers and other members of the clinical team, which helps create practice efficiencies. The first month of pump therapy is an especially important time when it comes to patient engagement. I communicate with patients on a near daily basis during the first week of pump therapy. I ensure they have an appointment in place with their endocrinologist or primary care provider 2 weeks after pump therapy is initiated. I am available for any questions that arise during that critical first month, and beyond. I’ve found this to be a very successful approach that creates greater practice efficiencies in the long run while also enhancing patient retention rates on pump therapy.

It’s also important from an efficiency standpoint to be mindful of communicating with patients’ providers once pump-start training/education are completed, and also when issues, concerns, or imbalances in blood sugars occur. Fixes can be easy, but first the provider needs to be aware of them.”

-Geneva Kennedy, CPT

Q: What are some best practices when it comes to patient education?

“An important best practice when it comes to creating efficiencies in diabetes education is remembering that we can’t do everything in every visit. This is also a strategy that helps ensure patients aren’t overwhelmed and they retain what we do tell them. If we try to teach patients everything in 1 visit, it results in information overload. This wastes our time and the patients’, because there’s no way they are going to remember all of it.

My approach is to identify the most important issue from a quick initial assessment, and then spend 20 to 30 minutes on that issue. I reinforce the most important things patients need to know and remember by repeating them and providing training materials as appropriate.

Patients get the most out of the appointment using this strategy and it results in the best outcomes for them.”

-Heather Leclerc, MS, RD, CDE

“When patients are initiating integrated pump therapy/CGM, I spend a considerable amount of time thoroughly explaining the difference between pump and sensor therapy and where they intersect. I also make clear that the insulin pump is first priority, and that CGM is (at first) supplemental. This helps patients prioritize their learning.

Regarding CGM, I tell patients just starting out that their only job initially is to get comfortable wearing the device. Utilizing CGM information can come later. I also strongly caution against turning on too many alarms and alerts right out of the gate. I typically suggest the low-glucose limit alert and Threshold Suspend® alarm to start. Ideally, we adjust these settings in the weeks to come.”

-Laurel Messer, RN, MPH, CDE

“Clear communication and patient follow-up are key components of my CGM training. I keep training efficient by letting patients know what to expect and striving to answer questions proactively.

I emphasize to patients the importance of overall trends, rather than getting caught up with a specific number at any given point in time. They also need to understand the difference between blood glucose and sensor glucose, so they aren’t concerned about slight variations between their fingerstick readings and the readings they see pictured on the screen of the pump.

I strongly encourage compliance with calibrations as well as keeping the pump and transmitter within ordered and appropriate distances.”

-Geneva Kennedy, CPT

Q: In what ways do you use technology to create efficiencies in your practice?

“By customizing a template for our electronic medical record (EMR) system, we now have a really slick hand-out that patients go home with that automatically prepopulates their insulin pump settings. The DEs in our practice worked with the EMR company to develop the template. It’s so much more efficient, and easier for the clinician.

The template also is prepopulated with some of the most common information we provide to pump patients, and you check off what you want to include. It’s a real time-saver so that you don’t have to type out the same recommendations for every patient. For example, 1 of the items that you can check off on the template is: “Don’t drink any sugared beverages, including juice.” Then that information is included on the handout when you print it out.

Not only is it easier to get patients out the door using the EMR template, they also have a handout to refer to at home. This tool is very useful and helpful while also supporting the patient.”

-Heather Leclerc, MS, RD, CDE

“For patients who use the MiniMed 530G with Enlite system, CareLink® Personal therapy management software downloads are a critical part of what we do. The information gleaned from the reports gives patients, their providers, and me essential information to drive more efficient care and support optimal outcomes.

I train patients on how to download the CareLink reports from home, and we discuss the importance, benefit, and value of doing so. Also, to improve adherence and make CareLink part of the patient’s regular routine, we decide on a day of the week on which the patient will consistently perform the downloads.”

-Geneva Kennedy, CPT

Getting started with the MiniMed® 530G insulin pump. Medtronic Diabetes. Accessed April 22, 2015.

Getting started with continuous glucose monitoring (CGM) for the MiniMed® 530G with Enlite. Medtronic Diabetes. Accessed April 22, 2015.

Sensors and transmitters: Why sensor glucose does not equal blood glucose. Medtronic Diabetes. Accessed April 22, 2015.

CareLink® Personal therapy management software. Medtronic Diabetes. Accessed April 22, 2015.