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Learning Objective 1: The learner will be able to identify an evidence-based approach for inpatient glucose management.
Learning Objective 2: The learner will be able to identify factors contributing to inpatient glucose control.
Methodology: The project methodology is based on the Plan, Do, Check, and Act approach. This cyclical process details the design of the new protocol, implementation of the basal-bolus concept with trained personnel in a medical unit, and evaluation of the pre and post data. The basis of the study is the evaluation of glycemic control and utilization process of a new subcutaneous insulin order set through data collection and analysis.
Outcomes: Based on the Society of Hospital Medicine Glucometrics, the following improvement in post data results are indicated: (1) Percentage of patients with Day Weighted Mean < 180 mg/dL (pre-37%; post-67%); (2) Percentage of days with hypoglycemia < 70 mg/dL (Pre-10%; Post-2%); (3) Percentage of days with hyperglycemia > 180 mg/dL (Pre-75%; Post-69%); (4) Percentage of days with extreme hyperglycemia > 300 mg/dL (Pre-29%; Post-8%);(5) Percentage of days within 80-180 mg/dL 75% of the time (Pre-20%; Post-48%). The overall clinical feedback is positive but includes suggestions for order set format and wording changes.
Significance: This pilot study validates the basal-bolus insulin management approach in glycemic control of non-critical care, medical patient population. The components of this order set assist in minimizing the risk of error in insulin therapy and promote optimal management of hyperglycemia. A system of clinical support including physician, advanced practice nurse, diabetic educator, clinical pharmacist, and registered dietitian is essential to the day-to-day glycemic control. Adherence to study protocol by staff nurses following education and competency affects patient outcomes. More importantly, the collaboration between bedside nurses and the multidisciplinary clinical support team leads to overall optimal patient glucose control.
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