Diabetes Planned Visit Algorithm
Diabetes planned visits let
patients become active participants in managing their diabetes. Patients set
goals with their providers on what actions they will take to improve their
health and manage their condition.
it is important to control blood pressure, blood glucose and lipids, but the
patient is in control of all daily decisions and actions required to reach
in managing diabetes requires patients to take control of the illness, set
meaningful self-management goals, and become competent in diabetes management.
education, handouts, and cajoling do not promote patient competence. The
greatest success has occurred when patients are encouraged to set the agenda of
the visit and coached in setting attainable and meaningful self-management
goals. Thus, the essential components of a planned visit for clinicians are to address
the concerns of the patient and then to partner with the patient to create a
self-management goal. If this process takes the entire 30 minutes of the visit
time, the patient should receive additional appointments to address issues such
as getting glucose, blood pressure, and lipids to goal and completing health
the patient ready for a diabetes planned visit?
if the patient is ready for diabetes planned visit or has another more
the patient is not ready for a diabetes planned visit, use regular a progress
note and re-schedule the diabetes planned visit.
patient is ready for a diabetes planned visit:
with Pre-Visit Questionnaire
the pre-visit questionnaire for serious symptoms (e.g., chest pain, stroke/transient
ischemic attack symptoms). Prioritize evaluation of potentially life- or limb-threatening
are no serious symptoms, record on the progress note the patient's answers to
the following pre-visit questionnaire questions:
- What is the most important thing you hoped to get from this visit?
- What concerns you most about your diabetes?
and clarify the answers to these questions and address the patient's concerns.
progress on previous self-management goal
"At the last visit, you planned to ... How did that go? Explore the patient's
insight into either "success" or "failure."
new Self-Management Goal Sheet
no goal is recorded:
- Review with the patient the importance and concept of self management.
- Use the Self-Management Goal Sheet try to work with patient to create a meaningful self-management goal.
- The goal should be an attainable small step to ensure success because effective self management is more likely with cumulative small successes.
- Review side two of the Self-Management Goal Sheet and review and discuss barriers and coping strategies.
- Revise self-management goal, if needed, and give it to the patient to take home and use as a guide.
- Record the new self-management goal on the front side of the diabetes planned visit progress note.
Tip: If goal is related to weight, diet, or glucose
control, consider a referral to a dietician for help with setting dietary self-management
- Review and confirm the patient's medication list. Update the green continuity sheet as needed.
- Review, explore, and record pertinent "positives" on diabetes planned visit progress note.
screening is positive, investigate and have the patient help prioritize. (Untreated
depression and stress makes self management more difficult.)
If not suicidal or homicidal, consider:
- Scheduling a medical evaluation as appropriate.
- Having the patient complete PHQ-9 Depression scale.
- Scheduling a follow up for depression discussion.
educational needs recorded on the pre-visit questionnaire.
educational handouts from the notebook and review then or near the end of the visit.
blood pressure.Consider intensification of regimen if the patient is not at
goal (systolic < 130, diastolic < 70). (Use Nursing Blood Pressure
heart and lungs.
deformities, calluses, skin breaks, vascular status, and any fungal infection.
Ask the patient to show how he or she checks the feet and tell you what he or
she is looking for. Follow up by asking the patient what he or she would do if redness,
swelling, broken skin, or an ulcer were present.
and record monofilament if not done within 1 year. Monofilament is not
necessary if neuropathy is already confirmed.
and explain the Diabetes Report Card results.
out prescription for labs for medication monitoring for the next diabetes
planned visit as appropriate. Fill out corresponding section on Diabetes
Management Report Card.
on follow up. If blood pressure or glucose are not at goal, schedule more
frequent, focused (15 minute) visits to get to goal. These do not need to be
diabetes planned visits. Consider nurse blood pressure checks or blood
pressure titration. Schedule
the next diabetes planned visit in 3 to 4 months if blood pressure, glucose,
and lipids are at goal. Write "Diabetes Planned Visit" on the return slip to ensure
30 minutes and lab date updates are scheduled.
that health maintenance is up to date. If it is not up to date, give patient a
Staying Healthy handout and either schedule or plan to discuss at next visit.
they understand about how they are doing.
will transpire before next visit.
Return to Diabetes Planned Visit Notebook Contents
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