Table 5

Patient and caregiver recommended solutions

Failures	Recommended solutions
Pretransplant
Diagnosis of DM not expected ‘I was not told this was a possibility before my transplant’	During the pretransplant education sessions, explain to patients that developing high blood sugar and needing medications can happen after transplantation.
Post-transplant discharge
Many different providers giving different sets of instructions at discharge ‘We can’t tell who is who’ ‘Too much information that does not register at that time’ ‘Dietician did not talk to me about diabetic diet’	Have the clinical teams work together to give one set of instructions (transplant, endocrine, nutrition) Colour code the discharge instructions by clinical service Provide a single list of emergency contact for each clinical service (transplant, endocrine) and telephone number Create a brochure that includes a picture, name, clinical service and role of all providers: Physician name Attending physician Endocrinology (diabetes)
Medication identification and training ‘We overshot ourselves’ ‘No one took this pen and told us how to uncap it’ ‘I created my own list [meds] since they were all not on it…’ ‘I was on syringes and had to switch to pens but was not trained on pens’	Provide patients with a chart with a picture of each medication that they will be taking, as part of the discharge instructions. Provide accurate training materials for each type of medication type and each delivery system
Insufficient or missing supplies ‘I ran out of the supplies right away’	Use patient-specific supplies for education and training prior to discharge Identify high-risk individuals who may require medication/supplies immediately
Insufficient explanation about importance of each medication, how it works and how long it works ‘I missed a dose and was so worried about it’	Provide a uniform discharge ‘packet’ with complete diabetes and medication information, including pictures of each medication
After discharge
Problems with making appointments after discharge ‘If they can schedule the first appointment for us… we haven’t even met the doctor…’	Make follow-up appointments before patient is discharged from the hospital
Communication after discharge ‘It was helpful to have one point contact throughout our care’	Patient portal (MyChart) is a very effective tool for communicating with physicians and providers Set patients up as early as possible with a MyChart account Help establish and refer patients to a ‘Patient Group’ that can provide peer support for new-onset DM Provide more support (eg, training, education materials) to help caregivers

DM, diabetes mellitus.