/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/ambulatory-delegation-protocols/,

/clinical/cckm-tools/content/delegationpractice-protocols/ambulatory-delegation-protocols/name-97375-en.cckm

201712346

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Ambulatory Delegation Protocols

Referral to Diabetes and Nutrition Education - Adult - Ambulatory [58]

Referral to Diabetes and Nutrition Education - Adult - Ambulatory [58] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


Delegation Protocol Number: 58

Delegation Protocol Title:
Referral to Diabetes and Nutrition Education - Adult - Ambulatory

Delegation Protocol Applies To:
UW Health Primary Care Clinics

Target Patient Population:
Patients with type 1 or type 2 diabetes or pre-diabetes

Delegation Protocol Champion:
Vanessa Rein, MD – Department of Medicine - Endocrinology

Delegation Protocol Reviewers:
Cheryl Franz, RN, BSN, CDE - Diabetes Care Coordinator
Megan Waltz, RD – Director, Culinary and Clinical Nutrition Services

Responsible Department:
Primary Care Departments
Department of Family Medicine
Department of Medicine (General Internal Medicine)

Purpose Statement:
To delegate authority from the patient’s UW Health Primary Care Provider to Registered Nurses (RNs) and
Registered Dietitians (RDs) to enter a referral to Diabetes Education for patients with diabetes.

Who May Carry Out This Delegation Protocol:
Registered Nurses and Registered Dietitian Nutritionists (RDNs) who have been trained in the use of this
delegation protocol.

Guidelines for Implementation:
1. The RN/RDN will review Health Link to identify patients qualifying for diabetes education.
2. Referral to Health Education
2.1. Qualifying patients:
2.1.1. Newly diagnosed with type 1 or type 2 diabetes
2.1.2. Previously diagnosed, but have had no diabetes education in ADA Recognized Program
2.1.3. Have an elevated A1c level (> target goal predetermined by provider), and have not had diabetes
education in an ADA Recognized Program for greater than six months.
2.1.4. Patient request.
2.1.5. Annual diabetes education update/refresher.
2.2. When a qualifying patient has been identified, the RN/RDN will place the referral order Diabetes
Education in Health Link.
2.3. If medication titration is determined the RN/RDN will route the order to the patient’s ordering provider.
3. Referral to Nutrition
3.1. Qualify patients:
3.1.1. Prediabetes
3.2. The RN/RDN will offer qualifying patients a referral to Clinical Nutrition. If the patient expresses interest
the RN/RDN will place an order for Consult to Clinical Nutrition.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org

4. If medication titration is deemed necessary the RN/RD will route to a provider.

Order Mode: Cosign Required, Protocol/Policy

References:
1. UW Health. Diabetes – Pediatric/Adult – Inpatient/Ambulatory Clinical Practice Guideline. 2015.
https://uconnect.wisc.edu/servlet/Satellite?cid=1126675405975&pagename=B_EXTRANET_UWH_HOME%2
FFlexMemberFile%2FLoad_File&c=FlexMemberFile
https://uconnect.wisc.edu/servlet/Satellite?cid=1126675405975&pagename=B_EXTRANET_UWH_HOME%2
FFlexMemberFile%2FLoad_File&c=FlexMemberFile.

Approved By:
UW Health Ambulatory Protocol Committee: September 2011; *June 2014; *April 2016
UW Health Clinical Knowledge Management Council: October 2011; *June 2014; *April 2016
UWHC Medical Board: November 2011; *August 2014; *April 2016
UWHC Chief Medical Officer: *August 2014; *April 2016

Effective Date: April 2016

Scheduled for Review: April 2019
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org