2.50
Hdl Handle:
http://hdl.handle.net/10755/157164
Category:
Abstract
Type:
Presentation
Title:
A Quality Approach to Glycemic Control
Author(s):
Reed, Charles; Benavidez-Medina, Irene; Legarde, Mario; Gerhardt, Susan; Pao, Wen; Ingram, Michelle; Payne, Michael
Author Details:
Charles Reed, University Hospital, San Antonio, Texas, USA, email: charles.reed@uhs-sa.com; Irene Benavidez-Medina; Mario Legarde; Susan Gerhardt; Wen Pao; Michelle Ingram; Michael Payne
Abstract:
PURPOSE: Damaging effects of hyperglycemia during critical illness have made glycemic control the standard of care in ICU's. As nurses and physicians struggle to successfully implement this practice on their units, a Process Improvement (PI) initiative was undertaken by University Hospital's adult intensive care units to address and remove the barriers for its adoption. Description: A team of ICU nurses and physician champions enlisted facilitators and analysts from the Quality department to guide them through the DMAIC process improvement model. After defining a primary aim and target blood glucose goal, the group exercised collective brainstorming to create the Ishikawa diagram to identify environmental and human aspect barriers to placing a patient on an insulin drip. Conceptual barriers were further identified and analyzed by issuing a survey of ICU nurses. These results were placed on a Pareto chart for additional analysis. Major barriers identified by the staff included a lack of knowledge about the insulin dosing protocol, nursing avoidance of Insulin drips, protocol deviations related to a fear of hypoglycemia, and physician failure to order the protocol. The team brainstormed improvement ideas, and selected solutions based on each unit's perceived barriers. The team developed algorithms for initiating the protocol and modified physician orders based on learning's from the PI activity. Each unit's champions then utilized these algorithms to in-service, pilot, and test the changes to the processes. Additionally, a data management software program was utilized for data mining and tracking improvements. EVALUATION: The Adult ICUs that had active champions and implemented the Process Improvement significantly improved the glycemic control of their patients. Protocol development standardized the approach to glycemic control and guided nursing and physician staff to transition between drips and sliding scales. Staff education increased awareness of the protocols and the importance of glycemic control. Access to real time data through the use of a data mining software program assisted in overcoming the fear of hypoglycemia. Additionally, data monitoring and early recognition permits protocol supervision and revision for improvement. One unit improved the percentage of values in the target range by 60%.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleA Quality Approach to Glycemic Controlen_GB
dc.contributor.authorReed, Charlesen_GB
dc.contributor.authorBenavidez-Medina, Ireneen_GB
dc.contributor.authorLegarde, Marioen_GB
dc.contributor.authorGerhardt, Susanen_GB
dc.contributor.authorPao, Wenen_GB
dc.contributor.authorIngram, Michelleen_GB
dc.contributor.authorPayne, Michaelen_GB
dc.author.detailsCharles Reed, University Hospital, San Antonio, Texas, USA, email: charles.reed@uhs-sa.com; Irene Benavidez-Medina; Mario Legarde; Susan Gerhardt; Wen Pao; Michelle Ingram; Michael Payneen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157164-
dc.description.abstractPURPOSE: Damaging effects of hyperglycemia during critical illness have made glycemic control the standard of care in ICU's. As nurses and physicians struggle to successfully implement this practice on their units, a Process Improvement (PI) initiative was undertaken by University Hospital's adult intensive care units to address and remove the barriers for its adoption. Description: A team of ICU nurses and physician champions enlisted facilitators and analysts from the Quality department to guide them through the DMAIC process improvement model. After defining a primary aim and target blood glucose goal, the group exercised collective brainstorming to create the Ishikawa diagram to identify environmental and human aspect barriers to placing a patient on an insulin drip. Conceptual barriers were further identified and analyzed by issuing a survey of ICU nurses. These results were placed on a Pareto chart for additional analysis. Major barriers identified by the staff included a lack of knowledge about the insulin dosing protocol, nursing avoidance of Insulin drips, protocol deviations related to a fear of hypoglycemia, and physician failure to order the protocol. The team brainstormed improvement ideas, and selected solutions based on each unit's perceived barriers. The team developed algorithms for initiating the protocol and modified physician orders based on learning's from the PI activity. Each unit's champions then utilized these algorithms to in-service, pilot, and test the changes to the processes. Additionally, a data management software program was utilized for data mining and tracking improvements. EVALUATION: The Adult ICUs that had active champions and implemented the Process Improvement significantly improved the glycemic control of their patients. Protocol development standardized the approach to glycemic control and guided nursing and physician staff to transition between drips and sliding scales. Staff education increased awareness of the protocols and the importance of glycemic control. Access to real time data through the use of a data mining software program assisted in overcoming the fear of hypoglycemia. Additionally, data monitoring and early recognition permits protocol supervision and revision for improvement. One unit improved the percentage of values in the target range by 60%.en_GB
dc.date.available2011-10-26T19:28:44Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:28:44Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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