2.50
Hdl Handle:
http://hdl.handle.net/10755/164180
Category:
Abstract
Type:
Presentation
Title:
Diabetes CNS Collaborates to Implement a New IV Insulin Method on Intermediate-Care Units
Author(s):
Davis, Ellen D.; Harwood, Kerry; Mabrey, Melanie; Midgett, Lea
Author Details:
Ellen D. Davis, MS, RN, CDE, Duke University Medical Center, Durham, North Carolina, USA, email: nacnsorg@nacns.org; Kerry Harwood, MSN, RN; Melanie Mabrey, MSN, ACNP, ADM-BC; Lea Midgett, BSN, RN
Abstract:
Purpose: Intravenous (IV) insulin has been shown to be an effective way to achieve tight control of blood glucose in hospital. Managing IV insulin is a labor-intensive task for nurses and is generally done in intensive-care units (ICU) with high nurse-to-patient ratios, 1:1 or 1:2. Many patients with severe hyperglycemia on intermediate-care units could benefit, as well, from tight control of blood glucose. We wanted to have intermediate-care nurses, with unit ratios of 1 to 5 or 6, to manage IV insulin. Significance: Evidence reveals that high blood glucose is a risk factor for poor clinical outcomes. Studies also show that tight glycemic control in hospital improves mortality and morbidity and reduces costs. The American Association of Clinical Endocrinologists and the American Diabetes Association in 2006 offered guidance for treating high blood glucose levels in all hospital patients. One recommendation was to implement structured protocols for aggressive control of blood glucose. Background/Design: Evidence reveals that high blood glucose is a risk factor for poor clinical outcomes. Studies also show that tight glycemic control in hospital improves mortality and morbidity and reduces costs. The American Association of Clinical Endocrinologists and the American Diabetes Association in 2006 offered guidance for treating high blood glucose levels in all hospital patients. One recommendation was to implement structured protocols for aggressive control of blood glucose. Methods: After observation of effectiveness of a novel approach to IV insulin in ICUs, the Diabetes Clinical Nurse Specialist (CNS) and a general medical Nurse Manager (NM) spearheaded a trial of the new IV insulin nomogram for three months on two intermediate-care units. The IV insulin nomogram would require not only hourly blood glucose measurements but also various calculations. In the educational sessions the CNS and NM introduced an audit tool and staff feedback mechanism. Findings: The three-month project ended with twenty-two patients who had 275 correct hourly rate calculations out of a possible 276. Conclusions: The nursing staff found the project challenging and satisfying. Audit results indicated that the nomogram could be used effectively on units with a 1:5 or 1:6 staffing ratio. Implications for Practice: With the success associated with the three-month project, we expanded to other adult units, and the CNS developed teaching guidelines. Nurses on other units have easily mastered the nomogram calculations, although some have voiced resistance to hourly blood glucose checks. Our successful experience with IV insulin on non-ICU units shows that patients with severe hyperglycemia can be managed by staff nurses on intermediate-care units and can reap the benefits of tight control of blood glucose in hospital.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2007
Conference Name:
CNS Outcomes: Ensuring Safety and Quality
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Phoenix, Arizona, USA
Description:
Conference theme: CNS Outcomes: Ensuring Safety and Quality, held February 28-March 1 in Phoenix, Arizona, 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.titleDiabetes CNS Collaborates to Implement a New IV Insulin Method on Intermediate-Care Unitsen_GB
dc.contributor.authorDavis, Ellen D.en_US
dc.contributor.authorHarwood, Kerryen_US
dc.contributor.authorMabrey, Melanieen_US
dc.contributor.authorMidgett, Leaen_US
dc.author.detailsEllen D. Davis, MS, RN, CDE, Duke University Medical Center, Durham, North Carolina, USA, email: nacnsorg@nacns.org; Kerry Harwood, MSN, RN; Melanie Mabrey, MSN, ACNP, ADM-BC; Lea Midgett, BSN, RNen_US
dc.identifier.urihttp://hdl.handle.net/10755/164180-
dc.description.abstractPurpose: Intravenous (IV) insulin has been shown to be an effective way to achieve tight control of blood glucose in hospital. Managing IV insulin is a labor-intensive task for nurses and is generally done in intensive-care units (ICU) with high nurse-to-patient ratios, 1:1 or 1:2. Many patients with severe hyperglycemia on intermediate-care units could benefit, as well, from tight control of blood glucose. We wanted to have intermediate-care nurses, with unit ratios of 1 to 5 or 6, to manage IV insulin. Significance: Evidence reveals that high blood glucose is a risk factor for poor clinical outcomes. Studies also show that tight glycemic control in hospital improves mortality and morbidity and reduces costs. The American Association of Clinical Endocrinologists and the American Diabetes Association in 2006 offered guidance for treating high blood glucose levels in all hospital patients. One recommendation was to implement structured protocols for aggressive control of blood glucose. Background/Design: Evidence reveals that high blood glucose is a risk factor for poor clinical outcomes. Studies also show that tight glycemic control in hospital improves mortality and morbidity and reduces costs. The American Association of Clinical Endocrinologists and the American Diabetes Association in 2006 offered guidance for treating high blood glucose levels in all hospital patients. One recommendation was to implement structured protocols for aggressive control of blood glucose. Methods: After observation of effectiveness of a novel approach to IV insulin in ICUs, the Diabetes Clinical Nurse Specialist (CNS) and a general medical Nurse Manager (NM) spearheaded a trial of the new IV insulin nomogram for three months on two intermediate-care units. The IV insulin nomogram would require not only hourly blood glucose measurements but also various calculations. In the educational sessions the CNS and NM introduced an audit tool and staff feedback mechanism. Findings: The three-month project ended with twenty-two patients who had 275 correct hourly rate calculations out of a possible 276. Conclusions: The nursing staff found the project challenging and satisfying. Audit results indicated that the nomogram could be used effectively on units with a 1:5 or 1:6 staffing ratio. Implications for Practice: With the success associated with the three-month project, we expanded to other adult units, and the CNS developed teaching guidelines. Nurses on other units have easily mastered the nomogram calculations, although some have voiced resistance to hourly blood glucose checks. Our successful experience with IV insulin on non-ICU units shows that patients with severe hyperglycemia can be managed by staff nurses on intermediate-care units and can reap the benefits of tight control of blood glucose in hospital.en_GB
dc.date.available2011-10-27T11:43:31Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:43:31Z-
dc.conference.date2007en_US
dc.conference.nameCNS Outcomes: Ensuring Safety and Qualityen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationPhoenix, Arizona, USAen_US
dc.descriptionConference theme: CNS Outcomes: Ensuring Safety and Quality, held February 28-March 1 in Phoenix, Arizona, 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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