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Improving Inpatient Diabetes Care: Nursing Issues

Improving Inpatient Diabetes Care: Nursing Issues. Rachel H. Girard, MS, RN, CDE Diabetes Nurse Specialist Maine Medical Center Portland, ME. Why Should Nurses Worry About “Tight” Glucose Control for Inpatients?. According to Florence Nightingale…….

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Improving Inpatient Diabetes Care: Nursing Issues

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  1. Improving Inpatient Diabetes Care: Nursing Issues Rachel H. Girard, MS, RN, CDE Diabetes Nurse Specialist Maine Medical Center Portland, ME

  2. Why Should Nurses Worry About “Tight” Glucose Control for Inpatients?

  3. According to Florence Nightingale…… • Nurses concern themselves with both the patient’s internal and external environments. • Nursing requires us to “put the patient in the best possible condition for nature to act upon him”.

  4. “Diabetes doesn’t kill inpatients, high blood sugar does”.

  5. Maine Medical Center is Committed to Safe Patient and Family-Centered Care!!

  6. Did you know that….? • JCAHO considers insulin to be one of the five highest-risk medications in the inpatient setting?

  7. Re-thinking Insulin Use…. • Basal (Background) • Nutritional • Correctional

  8. Basal (Background) Insulin • Lantus®(glargine) • Levemir® (detemir) • NPH

  9. Nutritional Insulin(scheduled ac dose) • Novolog® (aspart) • Humalog® (lispro) • Regular

  10. Correctional Insulin(according to sliding scale) • Novolog® (aspart) • Humalog® (lispro) • Regular

  11. Re-thinking Insulin Timing… • Insulin should be administered according to a blood sugar result obtained no more than 30 minutes prior to the dose. Beware of insulin dosing based on a “stale” BS result!

  12. Problem • Lack of synchronization between blood sugar testing, insulin injection and meals.

  13. Solution • BS --> SC insulin (nutritional and correctional) --> Meal

  14. Problem • Staff fear of hypoglycemia

  15. Solution • Hypoglycemia protocol • Recognize conditions which predispose to hypoglycemia • Reinforce benign nature of routine (and quickly corrected) hypoglycemia

  16. Problem • Staff frustration regarding insulin drip protocols

  17. Solution • Insulin drip protocols must be re-written to take into account VELOCITY of blood sugar changes!! • Consider use of a pre-meal sc insulin injection when a pt. on an insulin drip is also eating

  18. Problem • Inconsistent intake of CHO at mealtime without considering the insulin dose administered

  19. Solution • Greater appreciation of the CHO content of food

  20. Other issues for consideration.. • Will hospitals eventually be penalized for tolerating “loose” blood sugar control? • Are there enough glucose meters and pumps to implement this new inpatient program?

  21. Other issues for consideration… • What do we do with the patient who is “accidentally” diagnosed with DM while hospitalized? • Should a hemoglobin A1c be part of admission bloodwork for all patients known to have DM?

  22. Other issues for consideration… • What is the overall knowledge of staff with regard to diabetes? • Are there Diabetes Resource Nurses identified on all inpatient units?

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