East Cluster Meeting, July 1, 2009

East Cluster had another great meeting on Wednesday morning.

We began by rounding at our cluster board. We like very much the "How Was Your Day?" daily survey, which gives each cluster member the chance to rate their day, 0-5 (five is a great day). An envelope tacked to the board gives us a chance to explain in words why we chose that number. We're not sure yet how to respond to what we put in the envelope: should we talk daily to address those things or wait until our cluster meeting each week? We agreed that if somebody's day was a one (ugh!), we should not wait up to a week to improve that?

Any thoughts on that?

Another thing about the cluster boards. A lot of the stuff up there (charts and text) doesn't pass Cheryl's very wise "plain English" test, which says that anyone walking by the board should be able to figure out quickly and easily what the information up there is trying to say. There shouldn't be jargon, tiny print, or charts that require a PhD in statistics to interpret. So we marked up our board with suggestions for improving.

But we didn't agree on who owns the job of updating the board.

We moved from the board to the roundtable and heard from Shannon (Pharmacy) and Sherrie (RN) about their roles in Chronic Disease Management. Here's a summary:

Shannon can help our patients who take medications for chronic diseases get to their treatment goals if we ask her help. She has protocols to adjust doses for diabetes and high blood pressure medications, and will call or see patients in clinic to follow blood sugars, blood pressures, lab tests, help with motivation, personal barriers to self-care, and any questions our patients have about their medications. She doesn't have a big case load now, and would love to see more of our patients!

Remember that she also has a separate blood pressure program for patients without complicated disease whose blood pressure is uncontrolled.

Sherrie and Christine, our RNs also take on patients with chronic diseases, including diabetes, asthma, COPD, heart failure, and coronary artery disease. They have two kinds of services to offer:

1. A three month chronic disease management program that involves several face to face sessions and a lot of telephone and email follow up. This focuses on many aspects of helping patients live well with chronic diseases and is best suited to newly diagnosed patients or those having a hard time controlling their disease.
2. A "treat-to-target" program that focuses on specific goals identified by providers. An example would be adjusting insulin dosing until the patient has met a target blood sugar goal.

Whether using our pharmacist or nurses, we should first create a treatment plan for our patients that lays out for them what goals we have agreed to. These always go in the After Visit Summary (AVS, or patient instructions), and will serve as the "orders" that Shannon, Sherrie, and Christine will follow, so we should be clear what we're asking.

Phew.

We wrapped up by learning from Frank that extensive testing of the air in the East Cluster showed that it's pretty good. Nothing dangerous in it. There's more mold outside than in the building.

Great meeting!