Return demonstration and “teach back” are still the gold standard in problem solving re-admissions with diabetes complications.
Twice I have had patients re-admitted to inpatient care after repetition of DKA within 48 hours of last admission. Clearly, the patients were not receiving insulin. Both patients stated that they were giving themselves fresh insulin but their blood sugars would continue to rise.
I handed the insulin pen to each of these people at the time and asked them to describe the injections. Both stated they used a particular site because “I don’t feel it when I give it there.” Both described difficulty pressing the plunger end, stating: “Sometimes it jams up, so I just dial it down to zero to force the insulin in.”
Sites were palpated and noted to be thick with scar tissue from repeated injections in the same site. Re-instruction of insulin site rotation and pen use was given, to be sure they were aware that by dialing the insulin to zero- they were not forcing the insulin into the site, but were actually “un-dosing”- giving no insulin. I then asked patients to teach back, which they each did correctly.
- When teaching about any medication administration, always include the “teach back” method.
- When teaching about insulin or other injectable medication, teach the importance of site rotation and sites to avoid, such as scar tissue.
- For patients who do inject, assess sites at every visit
- It is very easy for pts to be labeled “non-compliant” when the problem goes much deeper.
- If the patient has repetitious problems, the HCP needs to dig deeper for the cause!
Andrea Lee Witt RN CDE
Diabetes Education Coordinator
Mercy Medical Center – Clinton
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