Vancouver Island Health Authority Pediatric Diabetes

Transcription

1 Vancouver Island Health Authority Pediatric Diabetes Did you know that: Vancouver Island is the same size as England? It takes 9-11 hours to drive from Sidney to Port Hardy We have the highest free falling water fall in the world? Della Falls

2 Travel!!! Some families need to take 2 ferries to get to Vancouver Island then several hours of driving to reach a Diabetes centre that cares for children.

3 Vancouver Island Community Locations Reference: Michele Fryer, VIHA

4 Three main VIHA centres that follow children with diabetes: 1. Victoria General Hospital (VGH) Covers Capital Regional District and Gulf Islands 2. Nanaimo Regional General Hospital Covers Central Island regions. 3. Campbell River and District Regional Hospital Covers North Island and some central regions. Some children are also supported at smaller Adult Centers on Vancouver Island (referrals to specialty service made to one of the above 3 centers)

5 VIHA or Vancouver Island Hospital Association VIHA (includes also the Gulf Islands) 2009 VIHA Estimate Population for Children < 19 of age Total 143,197 (Min. Health BC) Estimate 355 children followed with Diabetes Victoria total Nanaimo 69 total Campbell River 75 total (10 young adults no local Adult Endo)

6 Annual Number of Children Newly Diagnosed with diabetes VGH Nanaimo (initial teaching was done at VGH site) Campbell River ~ 8-10

7 VGH Clinic Team Members Pediatric Endocrinologist 2 clinics days per month (12-14 annually) - Dr.Suzanne Stock) 12 Local Pediatricians (Limited clinic support) Shared Nurse Clinicians/Diabetes Educators cover many clinics as well as Diabetes ( C.F., Endocrine, Oncology, HIV, Cardiology etc.) Shared Dietician Shared Social Worker

8 VGH Team continued Shared Psychologist Shared Child Life Specialist Community based Nursing Support Program Public Health Nursing for school support Provides initial teaching at diagnosis and ongoing education and support in an outpatient setting (individual, clinic sessions and phone support).

9 VGH Strengths Support from Dr.Suzanne Stock (invaluable) Strong experienced/extended Diabetes Team including Psychologist, Child Life Specialists etc.

10 Victoria Strengths Provides clinic, individual appointments and phone support. Initialize pump starts and ongoing support Excellent R.E.A.C.H. program (introduction back into school post diagnosis). At present trialing PHN providing program instead of Nurse Clinicians. Willing to share this useful program throughout BC if interested

11 VGH Strength's cont d Very supportive Pediatric Health Care Team Availability as support / resource for other community programs within VIHA (including Lady Minto on Saltspring, NRGH, etc.) Nurse Educators on-call for initial insulin adjustment over 1 st week including weekend Feedback and outcome from families - excellent

12 VGH Challenges Recent decrease in FTE Nurse Clinician - now 3 nurses cover 8 Clinic programs Increased support needed for expanding insulin pump starts Very few children have initial teaching done as outpatient this adds unnecessary inpatient costs and adds frustrations for families Lack of availability of Point of Care A1C s - limited to clinic days and specific number of tests per clinic

13 VGH Challenges Lack of Pediatrician clinic support -? a few committed Pediatricians as local experts to provide support for clinics, admissions and initiating insulin at diagnosis Lack of education for emergency and inpatient staff children using insulin pumps Inadequate funds for ongoing education of Team members and inpatient Nursing Staff Limited access to Psychology wait list Wish to participate in clinical trials and research

14 Nanaimo Diabetes Clinic Team Pediatric Endocrinologist 6 clinic days per year (Dr.Suzanne Stock) Newly formed program. Initiative funding provided by Child Health BC VIHA committed for long term funding. Presently not treating newly diagnosed children. Plan will include local service in future. Clinical role is being developed / implemented with the 5 Local Paediatricians

15 Nanaimo cont d Dietician shared with In-pt. Area 0.5 FTE Pediatric Nurse Educator and CPT Community Nursing Support Services Child Life Specialist shared hired Jan/ FTE Psychologist -? Hiring in Spring 09 Part time Social Work -? Hiring in Spring 09 NO Public Health Nursing support in schools

16 Nanaimo Clinic Strengths New designated clinic space anticipated in March 2009 present lack of space challenges clinic s function

17 Nanaimo Clinic Strengths Enthusiastic support by local Pediatricians to establish local clinic support for children newly diagnosed / ongoing needs Wish to initiate a model initial diagnosis and teaching that does not include lengthy admissions to hospital.

18 Nanaimo Challenges New clinic growth and increased need for local insulin pump starts Lack of support team members. Hope to have limited support by spring of Needs Point of Care A1C machine, supply funding and lab support Ongoing education for diabetes team and inpatient Nursing staff

19 Campbell River Clinic Pediatric Endocrinologist 1 clinics day every 2 months approx. 6 per year (Dr.Suzanne Stock) Dr.Lund monthly clinic Nurse Educator Shared Adult Diabetes team Dietician Shared Adult Diabetes team

20 Campbell River Clinic Follows children newly diagnosed with goal for early discharge and out.pt education / support Linked with Nursing Support Services

21 Strengths of Campbell River clinic: Provides early discharge at diagnosis and ongoing out.pt education / support Initiated without Pediatric funding because families were unable to access ongoing support in the Northern Island

22 Strengths of Campbell River clinic: Past experience in providing an excellent program in a remote area May be a useful model for other remote areas in B.C. Local social connections Camp Homewood Family Camp

23 Campbell River Challenges Increased funding and support for other team members such as Child Life Specialist, Social worker, psychology, etc. Ongoing education for diabetes team members and inpatient nursing staff. A1C machine is available but no budget ( money is donated for A1C testing strips)

24 Campbell River Challenges NO social work or child life specialist Lack of support and cooperation with Middle Schools.. Some issues of children feeling bullied at school because they have diabetes Would like to participate in clinical trials and research

25 Conclusion Perfectly summed up by Carmen, one of the young mothers followed at our clinic

26 Support and having someone there for us!!! When Tomas was diagnosed with diabetes we were devastated and petrified The warmth and support we had to help us learn what to do and to have someone to phone once we were home meant everything to us!

27 Conclusion: Thank you wonderful to have the opportunity to meet and share our expertise / knowledge and to assist families in the struggle diabetes presents.