The model we have developed for the Diabetes Management Service (DMS) consists
of a medical director (Dr. Annabelle Rodriguez, a board-certified endocrinologist),
nurse practitioner(s), certified diabetes educator(s), pharmacist(s), and data
The major focus of the DMS is for the nurse practitioner (NP) to actively manage
the daily blood glucose levels with medication adjustment. In our model, a
consultation is generated by the primary team via a computer order entering system.
Once the NP is apprised of the consultation, he/she performs a comprehensive
examination of the hospitalized patient. The NP is equipped with a wireless
laptop that contains a comprehensive Microsoft Access® database (which we developed
specifically for patients with diabetes and is available for purchase). Once
the NP has completed the initial consultation, he/she is able to print out the
forms for the medical chart while simultaneously updating the database. Maintenance
of the database was approved by the Johns Hopkins Institutional Review Board and
the database forms were approved by the Johns Hopkins Bayview Forms Committtee.
The NP evaluates patients on a daily basis during the course of their hospitalization.
In addition, to insure continuity of care, the NP sees discharged and new patients
two half-days per week in an outpatient endocrinology office adjacent to the main
The certified diabetes educator also is equipped with a wireless laptop that
contains a comprehensive Microsoft Access® database that we specifically developed
as an educational tool for hospitalized patients with diabetes mellitus (this
database can also be purchased separately from the NP database). The certified
diabetes educator works in a collaborative manner with the NP, and together a
plan is developed to educate patients and health care providers regarding the
best practices for diabetes care.
The pharmacist is an invaluable member of the DMS team. This person serves
as an important liaison with the Pharmacy and Therapeutics Committee. In our
experience, the pharmacist was extremely helpful in improving insulin sliding
scales, insulin infusion protocols and hypoglycemia protocols.
The data analyst is also an invaluable member of the DMS team. The
responsibilities of the data analyst included development and maintenance of
the two databases, and well as integration of data derived from the hospital's
databases. Monthly reports are generated which target outcomes such as length
of stay, case-mix index, readmission rates for patients with diabetes mellitus,
co-morbidities and the downstream impact to the institution.