2.50
Hdl Handle:
http://hdl.handle.net/10755/182512
Category:
Abstract
Type:
Presentation
Title:
Sweeter Is Not Better: Changing Practice Through Clinical Nursing Leadership
Author(s):
Jennings, Cathy
Author Details:
Cathy Jennings, RN, MSN, CNS-BC, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA, email: cjennings@carilion.com
Abstract:
Podium Presentation: BRIEF DESCRIPTION: This presentation describes the role of nursing leadership in the implementation of a glycemic control initiative focused on reducing morbidity and mortality in cardiac surgery patients. ABSTRACT: In today's healthcare environment, excellence in clinical practice demands critical application of current research. The area of glycemic control has recently yielded evidence with significant implications for clinical nursing practice. This presentation describes the role of nursing leadership in the implementation of a glycemic control initiative focused on reducing morbidity and mortality in cardiac surgery patients. In 2001, the cardiac surgery program at our Level I Trauma Center began using a modified Portland Protocol for glycemic control post-cardiac surgery, with a blood glucose goal of 150-200 mg/dL (1). In 2007, however, Clinical Practice Recommendations suggested that the lowest mortality in diabetic patients after cardiac surgery is seen when levels are maintained at <150 mg/dL (2). As a result, we convened an interdisciplinary team to develop a new "Metabolic Protocol," also adapted from the Portland Protocol, that requires continuous insulin infusion with close monitoring/titration to achieve optimal patient outcomes. We recognized that implementation of this evidence-based protocol would require changes in nursing practice. The clinical nurse specialist provided leadership to assist nurses to identify needed practice changes and available resources. For successful implementation, nurses had to learn the protocol and its physiologic basis, understand the protocol's process and its resultant impact on blood glucose levels, and change workflow to accomplish rigorous monitoring and treatment. Steps to achieve the change included developing a standard order set (with nursing reference algorithms), determining resource needs, educating staff on the evidence for change, and careful implementation. A pilot phase provided the opportunity for the clinical nurse specialist to monitor both process and outcomes. Nursing staff feedback led to modifications in the education and protocol prior to roll out. Nursing leadership is essential for achieving change: this leadership unites the team to identify barriers to change and strategies to overcome them. Lessons learned from this project include the importance of involving key stakeholders from the beginning, careful assessment of practice environment and nursing's readiness/willingness to embrace the change, and clinical guidance to enable the nurses to implement the protocol successfully. REFERENCES: 1. Furnary, A.P., Zerr, K.J., Grunkemeier, G.L., & Starr, A. (1999). Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Annals of Thoracic Surgery, 67, 352-362. 2. American Diabetes Association. (2007). Clinical practice recommendations 2007. Diabetes Care, 30 (supplement 1).
Repository Posting Date:
28-Oct-2011
Date of Publication:
28-Oct-2011
Conference Date:
2008
Conference Name:
ANCC National Magnet Conference
Conference Host:
American Nurses Credentialing Center
Conference Location:
Salt Lake City, Utah, USA
Description:
The 12th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 15-17 October, 2008 in Salt Lake City, Utah, 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.titleSweeter Is Not Better: Changing Practice Through Clinical Nursing Leadershipen_GB
dc.contributor.authorJennings, Cathyen_US
dc.author.detailsCathy Jennings, RN, MSN, CNS-BC, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA, email: cjennings@carilion.comen_US
dc.identifier.urihttp://hdl.handle.net/10755/182512-
dc.description.abstractPodium Presentation: BRIEF DESCRIPTION: This presentation describes the role of nursing leadership in the implementation of a glycemic control initiative focused on reducing morbidity and mortality in cardiac surgery patients. ABSTRACT: In today's healthcare environment, excellence in clinical practice demands critical application of current research. The area of glycemic control has recently yielded evidence with significant implications for clinical nursing practice. This presentation describes the role of nursing leadership in the implementation of a glycemic control initiative focused on reducing morbidity and mortality in cardiac surgery patients. In 2001, the cardiac surgery program at our Level I Trauma Center began using a modified Portland Protocol for glycemic control post-cardiac surgery, with a blood glucose goal of 150-200 mg/dL (1). In 2007, however, Clinical Practice Recommendations suggested that the lowest mortality in diabetic patients after cardiac surgery is seen when levels are maintained at &lt;150 mg/dL (2). As a result, we convened an interdisciplinary team to develop a new "Metabolic Protocol," also adapted from the Portland Protocol, that requires continuous insulin infusion with close monitoring/titration to achieve optimal patient outcomes. We recognized that implementation of this evidence-based protocol would require changes in nursing practice. The clinical nurse specialist provided leadership to assist nurses to identify needed practice changes and available resources. For successful implementation, nurses had to learn the protocol and its physiologic basis, understand the protocol's process and its resultant impact on blood glucose levels, and change workflow to accomplish rigorous monitoring and treatment. Steps to achieve the change included developing a standard order set (with nursing reference algorithms), determining resource needs, educating staff on the evidence for change, and careful implementation. A pilot phase provided the opportunity for the clinical nurse specialist to monitor both process and outcomes. Nursing staff feedback led to modifications in the education and protocol prior to roll out. Nursing leadership is essential for achieving change: this leadership unites the team to identify barriers to change and strategies to overcome them. Lessons learned from this project include the importance of involving key stakeholders from the beginning, careful assessment of practice environment and nursing's readiness/willingness to embrace the change, and clinical guidance to enable the nurses to implement the protocol successfully. REFERENCES: 1. Furnary, A.P., Zerr, K.J., Grunkemeier, G.L., & Starr, A. (1999). Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Annals of Thoracic Surgery, 67, 352-362. 2. American Diabetes Association. (2007). Clinical practice recommendations 2007. Diabetes Care, 30 (supplement 1).en_GB
dc.date.available2011-10-28T15:27:32Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T15:27:32Z-
dc.conference.date2008en_US
dc.conference.nameANCC National Magnet Conferenceen_US
dc.conference.hostAmerican Nurses Credentialing Centeren_US
dc.conference.locationSalt Lake City, Utah, USAen_US
dc.descriptionThe 12th American Nurses Credentialing Center (ANCC) National Magnet Conference, held 15-17 October, 2008 in Salt Lake City, Utah, USA.en_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.-
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