“She gained as much as she gave.” TMC Volunteer contributes to major improvements for diabetics’ care

Marjorie Zismann TMC Volunteer

Marjorie Zismann
TMC Volunteer

“You have diabetes.  Buy a book.”

That’s what Marjorie Zismann’s doctor told her when he diagnosed her with type 2 diabetes in her early 60’s.  Since then, attempts to understand her disease have left her completely frustrated. Every day, she weighs herself, pricks her finger, squeezes out a drop of blood to check her blood sugar and takes her medication. Mealtimes consist of sorting out “yes” foods from “no” foods, which leaves her feeling restricted with little control over her disease.

Now 78 years old and retired, Zismann volunteers at Tucson Medical Center. She was a patient here about a year ago, and was invited to be a patient advocate during what’s called a “kaizen.”  It’s a rapid-improvement workshop made up of about a dozen leaders from different departments who set out to tackle a very specific issue. The meeting is a crucial process of TMC’s journey to a Lean culture, which produces patient-focused, reliable, safe and compassionate care through continuous improvement and the purposeful use of our resources.

The challenge of this particular kaizen: improving glycemic management for TMC patients with type 1 diabetes and keeping them from having multiple hypoglycemic, or low blood sugar, events during their stay. For three days, members from pharmacy, dietary, and the diabetes educators, among others, dug into how to provide better care for these patients. “Every time an idea was pitched, we’d run it by Marjorie to get the patient perspective,” said Pat Ledin, a member of the TMC Lean Team, which organized the kaizen. “We’d ask her, ‘Would that help you? Would that offend you?  How would that make you feel?’ We can’t stress how important it is for us to hear the voice of our patients and involve them in every change and process improvement.”

The visual cue that was created to alert staff to patients at risk for hypoglycemic episodes

The visual cue that was created to alert staff to patients at risk for hypoglycemic episodes

Some improvements were made immediately, including educating the medical staff who are on the front lines. Special signs were created and placed on the doors of patients with diabetes to serve as a reminder to staff that a patient is at risk for hypoglycemia.  Finger sticks are done on a more consistent basis, which allows for more coordination with meal times. Pre-packaged “snack attacks” are readily available for when patients do have an episode. “These have the right number of carbohydrates and protein, so it’s the perfect snack for this type of patient. It’s bulletproof,” said Ledin. Supply kits have been streamlined, there is a standardized approach to what staff does with a patient’s medication, and there is more consistency in how these patients are cared for among different departments.

One thing the team found may be contributing to more hypoglycemic events – TMC’s On Demand Room Service, which allows patients the flexibility to call in their meals whenever they’d like. It’s without a doubt improved overall patient satisfaction scores, but for those with hypoglycemia, it can add confusion about appropriately coordinating meal times. TMC Lean Team leader Cheryl Young explains, “On Demand doesn’t work for these people because their insulin is associated with their mealtime. If they eat at 9 a.m. for example, and want to eat again at 11 a.m., our On Demand service allows them to do that. But if they do, it could cause a hypoglycemic event because the meals are too close together. It’s best to have at least four hours in between meals. So we’re educating these patients that although we have this service, it’s not necessarily the best thing for them and their disease.”  Another little nugget of information that Zismann has found invaluable at home.

“As a result of this kaizen, we now have a standardized approach for the food, medication, education and visuals for these patients,” said Young.

Just one month later – dramatic results.  “With these patients, their disease process causes the hypoglycemic event to happen. But now we are seeing the repetitious events minimized during their stay here, which is a direct result of the improvements put into place from the kaizen,” said Ledin.

Zismann said she learned more about her disease during those three days than she had since her diagnosis more than a decade ago. She discovered TMC has diabetes educators who are available to help patients. “For me, the most frustrating thing has been to try and figure out what I’m supposed to be doing,” said Zismann. “TMC Diabetes Educator Nancy Klug was tremendous. She opened my eyes to the fact that I CAN eat certain foods, I just can’t eat much of them. I left her office feeling so empowered, and relieved that I really didn’t need to be so restrictive!”

Zismann admits she still has a long way to go before fully understanding her disease, but calls the opportunity to join that kaizen “one of the best things that’s ever happened to her.” “I felt like part of the group,” she said. “These people care. They come up with wonderful ideas. They work well together. It was unbelievable to watch them, and I have learned so much from the experience.”

While Zismann is applauding their efforts, the kaizen team leaders insist they’re the ones who were fortunate to have her there.  “We were able to collectively come to better decisions that have already led to better outcomes for our patients because of what Marjorie brought to this process as both a patient and a volunteer,” said Young.  “I think she absolutely gained as much as she gave.”

If you are interested in acting as a patient adviser for a particular department or issue, please contact Angie Bush at (520) 324-5512 or Angie.Bush@tmcaz.com.

To contact a TMC Diabetes Educator, please call (520) 324-3526.

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Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461
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