PHILADELPHIA — Research presented at the American Association of Diabetes Educators Annual Meeting and Exhibition suggests that continuous education of staff may improve rates of hyperglycemia in hospitals.
By decreasing the rates of wound infections, catheter-related sepsis and length of hospital stay, researchers also stressed that the benefits of glycemic management extend beyond patient care by potentially saving $2.2 million a year in hospital costs.
The Marquette General Hospital, a Duke Lifepoint Hospital located in the Upper Peninsula of Michigan, implemented these changes after their hyperglycemia rate was 57% vs. the national benchmark of 31.7% and their hypoglycemia rate was 10.6% vs. the national benchmark of 3.5%. Beginning in June 2012, the Endocrine Service Line adopted their goal to decrease the hyperglycemia rate to 25% and the hypoglycemia rate to 9% while increasing outpatient diabetes referrals by 10% by October of the same year.
During the study, the Diabetes Task Force revised or designed an Adult Diabetes Order Set, an intensive insulin therapy, a diabetic ketoacidosis, a perioperative management and a diabetes discharge form.
Education on the changes started with the medical executive staff and continued hospital-wide with nurses and unit clerks. The education was held at monthly unit meetings and service line meetings. It included the Adult Diabetes Order Set; the utilization of basal, prandial and correctional insulin dosing; the appropriate course of action when blood glucose exceeds 180 mg/dL twice in the same patient; nurse-initiated hypoglycemia treatment; survival skills patient education; and use of an in-house created logbook.
The researchers implemented a new diabetes discharge plan which consisted of a portion on the overview of diabetes for the attending physician to complete and a section on meal planning, medication use, glucose testing and treatment plans for the nurse and dietary staff to complete. This discharge plan was faxed to the Outpatient Diabetes Education Department in Marquette where they called the local patients for follow-up appointments or sent the discharge plan to a certified diabetes educator in the patient’s local area for follow-up to occur.
The changes not only helped the hospital staff, but also the patients, the researchers wrote.
The hospital met and exceeded their goals by reducing the hyperglycemia rate to 25.8%, the hypoglycemia rate to 1.5%, while increasing the outpatient referrals by 100%.
Although their rates for hypo- and hyperglycemia dropped initially, they indicated that a slight rise occurred early in 2013. The task force continues to look at areas for improvement using the PDSA cycle for quality improvement, according to the researchers.
“This is not an easy process,” they wrote. “It takes much work by a task force of professionals. It also takes follow-up to evaluate continued success. The project is not over, it’s continuous.”
For more information:
Manty JL. #Rll. Presented at: American Association of Diabetes Educators Annual Meeting and Exhibition; August 7-10; Philadelphia.
Disclosure: The researchers report no relevant financial disclosures.