The flow sheet shown here is based on one developed by Family Health Associates, one of three Family Care Network pilot sites participating in a diabetes quality improvement project.
Diabetes Flow Sheet
Name:
Date of Birth:
HbA1c ≤ 7% (q 4-6 months)
Date:
Result:
Date:
Result:
Blood pressure ≤130/85 mm Hg
Date:
Result:
Date:
Result:
BUN/Creatinine ratio 8-22/0.4-1.1 mg/dL (annual)
Date:
Result:
Urine albumin/Creatinine 0-20 mg/L (annual)
Date:
Result:
Lipids (annual)
Date:
Chol:
Trig:
HDL:
LDL:
Retinal exam (annual)
Doctor:
Date:
Foot screening (annual)
High Risk: Yes No
Date:
Self-management
Date:
Goal:
Diabetic Education Dietary Consult Home Blood Glucose Monitoring ADA Membership
CAD Status: Past MI CABG PTCA Current Angina No History
Smoking Status:
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The flow chart may also serve as a reminder of crucial events of medical care that may effect the overall patients health.
The particular sample of a flow chart I chose would be a great reference for the onset of diabetes, yet I do not feel that the form would be a good reference tool for prolonged diabetic care. If I would have created this flow sheet I would have done it on graph paper or an excel spread sheet to allow for numerous date entries of data across the flow sheet. This way a Physician would be able to see at a glance what progress has been made on the care and control of the patients diabetes. If the chart shows little or no improvement or even a worse scenerio worsening of diabetes and its overall side effect the the Physician will know that either the patients diet and or medication will need to be adjusted