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Steps to Inpatient Management

Steps to Inpatient Management. Tamara R Meier, APRN-CNS INTEGRIS Baptist Medical Center. Objectives. Discuss early implementation of inpatient hyperglycemia management protocol Discuss hospital wide and ongoing education

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Steps to Inpatient Management

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  1. Steps to Inpatient Management Tamara R Meier, APRN-CNS INTEGRIS Baptist Medical Center

  2. Objectives • Discuss early implementation of inpatient hyperglycemia management protocol • Discuss hospital wide and ongoing education • Discuss implementation of hyperglycemia management protocol on impact of quality of care

  3. Learning • Identify key roles for successful implementation of systems/protocols • Processes to detect diabetes earlier in the hospitalization • The impact of an evidence based hyperglycemia management protocol on patient satisfaction

  4. Background • INTEGRIS Baptist Medical Center • 511 bed • Contracted • Ediba Diabetes Center of Excellence • 7 Steps of Inpatient Management • Outpatient DM education classes • 1 Endocrinologist • 1 RN

  5. Assessment • Gap Analysis • Key Roles • Planning • Education • ADA and AACE guidelines

  6. Key Roles • Physician • Endocrinology • Advanced Practice Nurse • Pharmacist • Dietary • Information Technology • Administration

  7. Education • Physicians • Nurses • Med Quality • Staff meetings • Classes

  8. Implementation • Hyperglycemia Management Protocol • Evidence based • Basic to specialized • One fits all • Replace all old sliding scales on protocols • Ongoing updates

  9. Processes • Order for HMP if FSBS >140 mg/dL • Check box on Order Sets • Nurse driven protocol • Earlier detection of Diabetes • Automatic order built into system • HgA1c • Not ordered if within the last 60 days • Task for >9%

  10. Ongoing Education • Hyperglycemia Protocol • Module • Annually • All RNs, LPNs • New Nurses to Organization • Metro Diabetes Class • Physicians • Residents

  11. Patient Satisfaction • Surveys • Monthly • Reports • >90% • Patient comments

  12. Impact on Quality of Care • Higher awareness of glycemic control • ALL patients • Earlier detection of prediabetes and DM • Better glycemic control • Reduces infection • Increases healing • Reduces length of stay • SCIP measure

  13. Protocols • Hyperglycemia Management (HMP) • Hypoglycemia • Intensive Insulin Infusion • Maintenance Insulin Infusion • DKA

  14. NOW at IBMC • The Joint Commission certifications • Advanced – Inpatient Diabetes • 1st in Oklahoma • Hyperglycemia • 1st in the US • Magnet Recognized • Ranked Best Regional Hospital • US News & World Report • High Performing – Diabetes & Endocrinology

  15. References • Ediba Diabetes Center of Excellence • Muchmore, J, et al. (2006). The Benefits of Inpatient Diabetes Care: Improving Quality of Care and the Bottom Line. Endocrine Practice (12, 3). • The Joint Commission. www.jointcommission.org

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