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MaineHealth/Miles Memorial Hospital Inpatient TARGET Diabetes Pilot

MaineHealth/Miles Memorial Hospital Inpatient TARGET Diabetes Pilot. Baseline Study – Burning Platform . Only sliding scales used no basal, bolus dosing Patient Education: 38% Therapy adjusted based on NPO status: 46% Percent of patients with hypo/hyper events: 72%

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MaineHealth/Miles Memorial Hospital Inpatient TARGET Diabetes Pilot

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  1. MaineHealth/Miles Memorial Hospital Inpatient TARGET Diabetes Pilot

  2. Baseline Study – Burning Platform • Only sliding scales used no basal, bolus dosing • Patient Education: 38% • Therapy adjusted based on NPO status: 46% • Percent of patients with hypo/hyper events: 72% • Avg # hypo/hyper events per patient per day: 1.4

  3. How we started • Oct. 2004 - Participated in the VHA Target Diabetes Inpatient Program • Got the tools and training to do it right! • Formed the Miles TARGET Diabetes Team Chartered -10/27/04 • Board Member w/ history of inpatient diabetes care • 2 Physicians • VP of Nursing • Nursing Unit Mgrs. • Staff nurse • Clinical Educator • Dietician • Diabetes Educator • Pharmacist • Quality Mgmt.

  4. Improvement Strategies/Action Steps Promoting Patient Self Management Changing Physician Practice Styles Improving Patient Education

  5. Keys to Success • Team, Physician, and Board Commitment to the Patient • Obtaining Physician Buy - In • Baseline VHA Study • Distribution of the ACE Position Paper & “Inpatient Management of Adults with Diabetes” literature • Distribution of the Yale-New Haven Diabetes Facts and Guidelines • Dr. Babirak (Endocrinologist) CME for providers • Obtaining Nursing Buy - In • Baseline VHA Study • Nursing Self Study Packets containing updated standards for inpatient diabetes care and new tools of the trade • Providing self-management tools to inpatients that mirror outpatient tools already being used by many physician offices in our community

  6. Overcoming Barriers • Availability of Tools/Location • Created prominently displayed holders specific for diabetes tools in the Medical Staff charting areas • Getting Nursing to Use the Tools • Even when diabetes was not a primary diagnosis • Provided education on the importance of tight glycemic control for ALL patients with diabetes • TARGET Diabetes Stickers were placed on ALL patient’s chart with a primary OR secondary diagnosis of diabetes • Changing Physician Behavior • DATA! • Bringing in expertise • Gentle reminders

  7. VHA Inpatient Diabetes

  8. Lessons Learned • Should have had the Endocrinologist speak to the Medical Staff earlier on in the process! • Needed to change to concurrent (daily) chart reviews instead of retrospective reviewing. This change allowed for: • Interventions for patients who had not yet received diabetes education, sub Q order sets, etc. • An “on the spot” opportunity to educate staff about new process • Time for the chart review process to be reduced • Need to make graphic self management tool part of the patient record

  9. Next Steps • Evaluate post op glycemic control in the ICU to ensure glucoses are <200 • Develop a DKA protocol • Reduce variation in glucose values (post 24 hrs.) on Med-Surg unit through continued reinforcement of basal, bolus dosing, and through using the self-management tool to graphically display patient glucoses over time

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