2.50
Hdl Handle:
http://hdl.handle.net/10755/163867
Category:
Abstract
Type:
Presentation
Title:
Timing of Blood Glucose Monitoring and Sliding Scale Coverage
Author(s):
Helmuth, Amy; Fowler, Kimberly
Author Details:
Amy Helmuth, RN, MS, Pinnacle Health System, Harrisburg, Pennsylvania, USA, email: nacnsorg@nacns.org; Kimberly Fowler, RN, MSN
Abstract:
Statement of Problem: More than 4.2 million hospitalizations occur annually for persons with diabetes. Studies note potential reduction in morbidity, mortality, length of stay and cost when blood glucose levels are below 200mg/dL. Glycemic control is a multidisciplinary goal. Bedside capillary blood glucose monitoring (CBGM) allows for rapid determination of blood glucose levels throughout the day. Purpose: The Clinical Nurse Specialist (CNS) and Manager of Performance Improvement identified inconsistencies and often long delays in insulin sliding scale coverage after CBGM was performed. A preliminary investigation will be conducted to determine: 1) What is our current practice for performing CBGM and providing sliding scale insulin coverage? 2) Is there a significant change in the CBGM result and subsequent coverage if there is a delay in treatment? 3) Is there a relationship between timing of CBGM and timing of insulin coverage administration and glycemic control/ incidence of hypoglycemic episodes? Significance: Approximately 3000 patients are admitted to PinnacleHealth System hospitals annually with a principal or secondary diagnosis of diabetes. CBGM is performed approximately 72, 000 times annually with insulin sliding scale coverage as needed. The CNS on a medical cardiac telemetry unit received concerns from the RN staff that inconsistencies existed in the timing of CBGM and administration of insulin coverage. CBGM is obtained by the Patient Care Assistant (PCAs) near the end of night shift. The CNS interviewed PCAs and found that the CBGM may be performed anytime from 0400 - 0630. Coverage of a hyperglycemic event may be done by the night shift RN or the dayshift RN in conjunction with the daily insulin. A Description of the Practice Change: In the summer of 2003, the CNS and Manager of Performance Improvement will conduct a preliminary investigation to determine the impact of current practice on glycemic control. If current practice is found to have a negative effect on glycemic control or frequency of hypoglycemic episodes, standardization of the timing of CBGM and insulin coverage administration will be recommended. Evaluation: The following data will be collected to evaluate the research questions: time of CBGM and result, time of insulin administration, CBGM result immediately prior to insulin administration, subsequent CBGM results, and hypoglycemic events. The CNS will review each CBGM to identify the frequency with which the routine CBGM glucose level differed significantly from the glucose value obtained immediately prior to administering insulin coverage. The CNS will record if the difference in CBGM glucose values resulted in the need for a different dose of insulin coverage. Implications for Practice: The CNS and Manager of Performance Improvement will work with the department of nursing to redesign the method of obtaining CBGM and providing insulin coverage. System-wide education will be required for all PCAs and RNs. Data will be collected to indicate if standardization of timing for CBGM and insulin coverage administration has a positive effect on patient outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2004
Conference Name:
2004 NACNS Conference, Renaissance in CNS Practice: Transforming Nursing in the 21st Century
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
San Antonio, Texas, USA
Description:
Conference theme: Renaissance in CNS Practice: Transforming Nursing in the 21st Century, held on March 11 to 13, 2004 in San Antonio, Texas, 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_US
dc.typePresentationen_GB
dc.titleTiming of Blood Glucose Monitoring and Sliding Scale Coverageen_GB
dc.contributor.authorHelmuth, Amyen_US
dc.contributor.authorFowler, Kimberlyen_US
dc.author.detailsAmy Helmuth, RN, MS, Pinnacle Health System, Harrisburg, Pennsylvania, USA, email: nacnsorg@nacns.org; Kimberly Fowler, RN, MSNen_US
dc.identifier.urihttp://hdl.handle.net/10755/163867-
dc.description.abstractStatement of Problem: More than 4.2 million hospitalizations occur annually for persons with diabetes. Studies note potential reduction in morbidity, mortality, length of stay and cost when blood glucose levels are below 200mg/dL. Glycemic control is a multidisciplinary goal. Bedside capillary blood glucose monitoring (CBGM) allows for rapid determination of blood glucose levels throughout the day. Purpose: The Clinical Nurse Specialist (CNS) and Manager of Performance Improvement identified inconsistencies and often long delays in insulin sliding scale coverage after CBGM was performed. A preliminary investigation will be conducted to determine: 1) What is our current practice for performing CBGM and providing sliding scale insulin coverage? 2) Is there a significant change in the CBGM result and subsequent coverage if there is a delay in treatment? 3) Is there a relationship between timing of CBGM and timing of insulin coverage administration and glycemic control/ incidence of hypoglycemic episodes? Significance: Approximately 3000 patients are admitted to PinnacleHealth System hospitals annually with a principal or secondary diagnosis of diabetes. CBGM is performed approximately 72, 000 times annually with insulin sliding scale coverage as needed. The CNS on a medical cardiac telemetry unit received concerns from the RN staff that inconsistencies existed in the timing of CBGM and administration of insulin coverage. CBGM is obtained by the Patient Care Assistant (PCAs) near the end of night shift. The CNS interviewed PCAs and found that the CBGM may be performed anytime from 0400 - 0630. Coverage of a hyperglycemic event may be done by the night shift RN or the dayshift RN in conjunction with the daily insulin. A Description of the Practice Change: In the summer of 2003, the CNS and Manager of Performance Improvement will conduct a preliminary investigation to determine the impact of current practice on glycemic control. If current practice is found to have a negative effect on glycemic control or frequency of hypoglycemic episodes, standardization of the timing of CBGM and insulin coverage administration will be recommended. Evaluation: The following data will be collected to evaluate the research questions: time of CBGM and result, time of insulin administration, CBGM result immediately prior to insulin administration, subsequent CBGM results, and hypoglycemic events. The CNS will review each CBGM to identify the frequency with which the routine CBGM glucose level differed significantly from the glucose value obtained immediately prior to administering insulin coverage. The CNS will record if the difference in CBGM glucose values resulted in the need for a different dose of insulin coverage. Implications for Practice: The CNS and Manager of Performance Improvement will work with the department of nursing to redesign the method of obtaining CBGM and providing insulin coverage. System-wide education will be required for all PCAs and RNs. Data will be collected to indicate if standardization of timing for CBGM and insulin coverage administration has a positive effect on patient outcomes.en_GB
dc.date.available2011-10-27T11:40:37Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:40:37Z-
dc.conference.date2004en_US
dc.conference.name2004 NACNS Conference, Renaissance in CNS Practice: Transforming Nursing in the 21st Centuryen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationSan Antonio, Texas, USAen_US
dc.descriptionConference theme: Renaissance in CNS Practice: Transforming Nursing in the 21st Century, held on March 11 to 13, 2004 in San Antonio, Texas, USAen_US
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.en_US
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