Kelly Ranson, MSN, PHN, CCHP, Chief Nurse Executive at Kern Valley State Prison in Delano, CA joins Lorry to discuss implementing diabetic self-care at her facility. Kelly recently graduated from the California State University MSN program. This project was part of her graduate studies.
Tips for Making Change Happen
It is not easy to change practice in traditional clinical settings but there are added barriers to health care innovations in a correctional setting. Kelly provides a real-life perspective on how she went about initiating her diabetic self-care project.
- Pick something you are passionate about. It will keep you motivated when the going gets rough. Kelly has a personal connection with diabetes in her own family as well as having a graduate school class project requirement related to chronic diseases.
- Seize an opportunity when it comes along, no matter the original reason. Kelly took advantage of an institutional decision for inmates to carry glucometers that originated as a staff work-reduction action.
- Research the evidence to support the change you want to make. Kelly researched national diabetes standards but also included World Health Organization information for 3rd world countries as the prison environment has many similarities.
- Consider what the facility leadership is interested in and link to that. Kelly connected the innovation with fiscal savings in reducing late-stage diabetes health care costs.
- Consider the down-side of the innovation and make accommodations. Kelly and the Warden disassembled the glucometers and lancets to determine if they could be used to create a weapon.
- Start it as a trial. Administration may be willing to trial a change knowing that it can be pulled back if unsurmountable difficulties arise.
- Be a hero on the patient side and the taxpayer side. Kelly linked improving patient care to reducing costs to gain management engagement.
- Include some of the nay-sayers into the implementation team. Kelly involved the nurses who were skeptical about the success of the program with lifer inmates. They became the champions of the program through their early involvement.
- Involve the patient population early on. Kelly and her team met with the inmate advisory group and got their support before implementation.
The recent measles outbreak is the largest in the US since the vaccine became universally available. The American Academy of Pediatrics recently released updated measles guidelines in response to this national outbreak. Of importance for correctional practice is the recommendation for vaccination of unvaccinated adults born after 1957 who have not had the disease. If you are in an outbreak state, your facility may be considering measles vaccination in the near future.
A study recently published in the New England Journal of Medicine found 17% more fatalities caused by smoking than originally noted in an examination of five large databases of over 180,000 fatalities. Twenty one common diseases are associated with cigarette smoking but previously unrecognized smoking-related deaths were discovered. Some interesting findings from this study were that death from infection was 2.3 times higher in smokers and cirrhosis of the liver was 3.1 times higher. The good news is that the elevated risks decrease over time if a smoker quits. So, the move to smoke-free correctional facilities is definitely a positive health move for our patients.
A new meta-analysis of 6 dietary trials involving over 2000 participants was published in OpenHeart, an imprint of the British Medical Journal in partnership with the British Cardiovascular Society. Turns out those dietary guidelines we’ve been using to teach our patients and guide medical diets are not evidence-based. In fact, there is no data to support the recommendations to keep dietary fat less than 30% and saturated fats less than 10%. In this age of evidence-based medicine, it is interesting that so much of our practice is built on a shaky foundation.
What is your take on these news items? Share your thoughts in the comments section of this post.