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EBP REPORT- TEAM OUTLAW

EBP REPORT- TEAM OUTLAW. By Susan Outlaw, Melissa Ashley, Mary Holston, & Beverly McMilion October 17, 2013. Project Overview. Introduction Patient/Situation Focused Question Target Resources/Evidence Relevance of Evidence Evidence Appraisal Action/Implementation and Evaluation

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EBP REPORT- TEAM OUTLAW

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  1. EBP REPORT- TEAM OUTLAW By Susan Outlaw, Melissa Ashley, Mary Holston, & Beverly McMilion October 17, 2013

  2. Project Overview • Introduction • Patient/Situation Focused Question • Target Resources/Evidence • Relevance of Evidence • Evidence Appraisal • Action/Implementation and Evaluation • Conclusion

  3. Introduction

  4. Diabetes Mellitus • Type I (IDDM) • Diagnosed in childhood • Autoimmune destruction of beta cells • Treatment is Insulin replacement therapy, diet & exercise • Symptoms include polyuria, polydipsia, polyphagia, weight loss, fatigue • Type II (NIDDM) • Usually diagnosed in adults • Treatment may or may not include insulin, other medications, diet and exercise • Symptoms include polydipsia, polyphagia, polyuria, blurred vision, slow healing wounds, & weight loss

  5. Case Study The case study involves Amy, a 36 year old Caucasian female, admitted to the hospital and placed on an insulin drip due to her blood sugar of 300. Amy is an overweight smoker, a heavy drinker, and is nonadherent to her home insulin regimen. The hospital insulin drip protocol is to maintain serum blood sugar between 70 and 110 mg/dl. Recently a pilot research project indicated that a mean serum blood sugar for patients discharged from cardiac care units was 148. The nurses caring for Amy question if the current protocol ranges are appropriate.

  6. Focused Question What is the highest level of evidence available in determining if the hospital’s current insulin drip protocol to maintain serum blood glucose levels between 70 and 110 mg/dl is effective for a 36 year old Caucasian female who is an overweight smoker, heavy drinker, and non-adherent to her home insulin regimen and has been admitted to the hospital with blood sugar of 300 and placed on an insulin drip?

  7. Targeted Resources

  8. LEVEL OF EVIDENCE • Highest available evidence • Alternative Search Words • Meta-analysis • Systematic reviews • Peer reviewed • Random control trials

  9. PPAARE QUESTION FOR CASE STUDY FOCUSED QUERY QUESTION

  10. PROBLEM • Is the hospital insulin drip protocol effective for the patient? • Alternative search words • Efficacy of insulin protocol • Diabetes • Treatment

  11. PATIENT

  12. Relevant Evidence • The highest level of evidence from numerous research designs such as meta-analysis, quantitative, qualitative, and Random Control Trials were utilized to determine and evaluate literature and identify the safety and efficacy of insulin infusion therapy for a defined glycemic range. • Population included adult medical/surgical and critical care patients receiving Continuous Insulin Infusion.. Exclusions were children, other hypoglycemic and anti-diabetic drugs. • Data collection methods included clinical questions to analyze data base searches, clinical variables and Acute Physiology and Chronic Health Evaluation II (APACHE II), clinical interventions from patient charts, nursing records, and in-depth interviews transcribed using Ground Theory Approach. • Data analysis methods utilized were tape recorded transcribed Maxqda 2007 in 3 phases of coding per review, blood glucose values of patients were compared using the Student’s ttest and Wilcoxon rank-sum test, and retrospective analysis of 200 consecutive patients receiving CII.

  13. ACTIONS • Maintain realistic blood glucose control while in hospital • Alternative Search Words • Blood glucose monitoring • Hyperglycemia • Insulin • Glycemic control

  14. ALTERNATIVE • None

  15. PATIENT RESULTS • Establish individualized blood glucose protocol to achieve optimal outcome • Alternative Search Words • Effective blood sugar control • Optimal outcomes • Decrease complications • Perceptions • Experiences

  16. COURSE OF ACTION • Adopt a new insulin drip protocol to maintain serum blood glucose levels between 110 and 150 mg/dl. • Establishing a written protocol of referrals for patients on insulin infusion • Discharge planning and education to begin on day one of hospitalization • Monitor, evaluate and review blood glucose levels on patients receiving insulin infusion, t mortality, and hospital readmit rates in this patient population to evaluate effectiveness of newly established protocol

  17. CONCLUSION • Tight glycemic control (target of 80-110 mg/dL) in ICU has increased risk of severe hypoglycemia • The ADA/AACE Inpatient Task Force now recommends against tight glycemic control (80-110 mg/dL) for patients in the ICU and suggests new glycemic targets (140-180 mg/dl) are more reasonable, achievable, and safer in patients receiving CII in the ICU setting.

  18. REFERENCES Adams, M. P., Holland, N., & Urban, C. (2014). Pharmacology for nurses: A pathophysiologic approach (4th ed.). Boston: Pearson. Bailey, V., Dziura, J., Goldberg, P., Halickman, J., Inzucchi, S., Lee, M., Lee, S., Sherman, R., & Siegel, M. (2004). Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care, 27(2), 461-467. doi: 10.2337/diacare 27.2461. Retrieved from: http://care.diabetesjournals.org/content/27/2/461.long Bilo, H.J.G., Hortensius, J., Jaap, J., Kars, M.C., Kleefstra, N., & Wierenga, W. S. (2012). Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study. BioMed Central Public Health, 12:167. doi: 10.1186/1471-2458-12-167. Retrieved from: http://www.biomedcentral.com/1471-2458/12/167 Jacobi, J., Bircher, N., Krinsley, J., Agus, M., Braithwaite, S., Deutschman, C., … Schunemann, H. (2012). Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Critical Care Medicine, 40(12), 3251-3276. DOI: 10.1097/CCM.0b013e3182653269. Retrieved from: http://www.learnicu.org/SiteCollectionDocuments/Glycemic_Control.pdf Smiley, D., Rhee, M., Limin, P., Roediger, L., Mulligan, P., Satterwhite, L.,…Umpierrez, G. (2010). Safety and efficacy of continuous insulin infusion in noncritical care settings. Journal of Hospital Medicine: An official publication of the society of hospital medicine. 5(4), 212-217. doi: 10.1002/jhm.646 Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/2039402

  19. Questions/Comments

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