2.50
Hdl Handle:
http://hdl.handle.net/10755/182727
Category:
Abstract
Type:
Presentation
Title:
An Innovative Approach for Management of Inpatient Hyperglycemia
Author(s):
D'Luna-O'Grady, Lubelle
Author Details:
Lubelle D'Luna-O'Grady, MSN, RN, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA, email: Lubelle.Dluna-Ogrady@hoaghospital.org
Abstract:
Poster Presentation: Purpose: An innovative intensive insulin protocol was developed to provide clear consistent guidelines for management of inpatient hyperglycemia and established the framework for nurses to lead this initiative. The protocol is facilitated by RNs with the goal to maintain blood glucose (BG) between 80 to 110 mg/dl. Description: A collaborative, multidisciplinary team created the Insulin Protocol initiated in November 2005. The protocol uses subcutaneous insulin analogs, Lantus and Novolog, which are known to closely mimic the body's physiologic insulin response to meals, as compared to other basal insulin, such as NPH. It uses a basal-bolus approach to insulin dosing, a proactive approach to BG management, as compared to insulin sliding scale (ISS), a reactive attempt to correct BG levels. One of four insulin algorithms is selected, based on the patient's insulin sensitivity needs. Dosing is based on BG level, amount of carbohydrate eaten per meal, and basal requirements. The protocol provides for controlling blood glucose when receiving TPN, enteral feedings or when NPO. Evaluation/Outcomes: Outcomes included eliminating insulin sliding scale and oral hypoglycemic use in the hospital, standardizing the types of insulin used and facilitating RN competency to manage inpatient hyperglycemia. Working with private physicians the RNs transformed their healthcare environment by consistently advocating improvement in blood glucose management for their patients. Outcome measures include consistently close to 100% of patients being provided glycemic control based on the protocol. All RNs on hire receive education on the science and methodology for blood glucose management. Nurses embraced the change as it was evidence based and the outcomes were positive with this nurse led initiative. Initial assessment of RN knowledge acquisition was measured before and after education was provided with a definite improvement in mean score. Data collected and compared to date reflects...[Please contact the primary investigator for more information about this poster presentation.] REFERENCES: American College of Endocrinology (AACE) (2002).Diabetic Guidelines. Endocrine Practice. (8): supplement 1. 40-82. American Diabetic Association. (Online. www.americandiabetesassociation.org, 2007). Barnum, B.J.S. (1994) Nursing Theory. Analysis, Application, Evaluation. J.B. Lippincott. Philadelphia. Brownlee, M.; Hirsch.I. (2006), Glycemic Variability : A hemoglobin A1c-independent risk factor for diabetic complications. JAMA. 295 (14). 1707-1708. Clement, S.; Braithwaite, S.S.; Magee M.F.; Ahmann, A.; Smith E.P.; Schaffer, R.G.; Hirsch I.B. (2004) Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 27:553-591. Garber, A.H.; Moghissi E.S.; Bransome E.D. et al. (2004) American College of Endocrinology position statement on inpatient diabetes and metabolic control. Endocrine Practice. (10). (1): 77-82. Hirsch, I.B. (2006) In-hospital Diabetes Care. Physicians Weekly. 21. (41).1-4. Hirsch, I.B.; Braithwaite, S.S.; Verderese, C.A. (2005) Practical Management of Inpatient Hyperglycemia. Hilliard Publishing. King, A.; Armstrong, D. (2005) Basal bolus dosing, how to deliver insulin like a pancreas. Diabetes Health. 6.21-22 Magnet Recognition Program - Application Manual - ANCC 2005 Magnet Force #5 Professional Models of Care "Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practice and are the coordinators of care." Magnet Force #9 Autonomy "Nurses are permitted and expected to practice autonomously, consistent with professional standards. Independent judgment is expected to be exercised within the context of a multidisciplinary approach to patient care." Nursing Practice Act State of California, Scope of Regulation Excerpt from Business and Profession Code Division 2, Chapter 6. Article 2 Orem, D.E. (1991 ...[Please contact the primary investigator for additional references.]
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.titleAn Innovative Approach for Management of Inpatient Hyperglycemiaen_GB
dc.contributor.authorD'Luna-O'Grady, Lubelleen_US
dc.author.detailsLubelle D'Luna-O'Grady, MSN, RN, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA, email: Lubelle.Dluna-Ogrady@hoaghospital.orgen_US
dc.identifier.urihttp://hdl.handle.net/10755/182727-
dc.description.abstractPoster Presentation: Purpose: An innovative intensive insulin protocol was developed to provide clear consistent guidelines for management of inpatient hyperglycemia and established the framework for nurses to lead this initiative. The protocol is facilitated by RNs with the goal to maintain blood glucose (BG) between 80 to 110 mg/dl. Description: A collaborative, multidisciplinary team created the Insulin Protocol initiated in November 2005. The protocol uses subcutaneous insulin analogs, Lantus and Novolog, which are known to closely mimic the body's physiologic insulin response to meals, as compared to other basal insulin, such as NPH. It uses a basal-bolus approach to insulin dosing, a proactive approach to BG management, as compared to insulin sliding scale (ISS), a reactive attempt to correct BG levels. One of four insulin algorithms is selected, based on the patient's insulin sensitivity needs. Dosing is based on BG level, amount of carbohydrate eaten per meal, and basal requirements. The protocol provides for controlling blood glucose when receiving TPN, enteral feedings or when NPO. Evaluation/Outcomes: Outcomes included eliminating insulin sliding scale and oral hypoglycemic use in the hospital, standardizing the types of insulin used and facilitating RN competency to manage inpatient hyperglycemia. Working with private physicians the RNs transformed their healthcare environment by consistently advocating improvement in blood glucose management for their patients. Outcome measures include consistently close to 100% of patients being provided glycemic control based on the protocol. All RNs on hire receive education on the science and methodology for blood glucose management. Nurses embraced the change as it was evidence based and the outcomes were positive with this nurse led initiative. Initial assessment of RN knowledge acquisition was measured before and after education was provided with a definite improvement in mean score. Data collected and compared to date reflects...[Please contact the primary investigator for more information about this poster presentation.] REFERENCES: American College of Endocrinology (AACE) (2002).Diabetic Guidelines. Endocrine Practice. (8): supplement 1. 40-82. American Diabetic Association. (Online. www.americandiabetesassociation.org, 2007). Barnum, B.J.S. (1994) Nursing Theory. Analysis, Application, Evaluation. J.B. Lippincott. Philadelphia. Brownlee, M.; Hirsch.I. (2006), Glycemic Variability : A hemoglobin A1c-independent risk factor for diabetic complications. JAMA. 295 (14). 1707-1708. Clement, S.; Braithwaite, S.S.; Magee M.F.; Ahmann, A.; Smith E.P.; Schaffer, R.G.; Hirsch I.B. (2004) Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 27:553-591. Garber, A.H.; Moghissi E.S.; Bransome E.D. et al. (2004) American College of Endocrinology position statement on inpatient diabetes and metabolic control. Endocrine Practice. (10). (1): 77-82. Hirsch, I.B. (2006) In-hospital Diabetes Care. Physicians Weekly. 21. (41).1-4. Hirsch, I.B.; Braithwaite, S.S.; Verderese, C.A. (2005) Practical Management of Inpatient Hyperglycemia. Hilliard Publishing. King, A.; Armstrong, D. (2005) Basal bolus dosing, how to deliver insulin like a pancreas. Diabetes Health. 6.21-22 Magnet Recognition Program - Application Manual - ANCC 2005 Magnet Force #5 Professional Models of Care "Models of care are used that give nurses the responsibility and authority for the provision of patient care. Nurses are accountable for their own practice and are the coordinators of care." Magnet Force #9 Autonomy "Nurses are permitted and expected to practice autonomously, consistent with professional standards. Independent judgment is expected to be exercised within the context of a multidisciplinary approach to patient care." Nursing Practice Act State of California, Scope of Regulation Excerpt from Business and Profession Code Division 2, Chapter 6. Article 2 Orem, D.E. (1991 ...[Please contact the primary investigator for additional references.]en_GB
dc.date.available2011-10-28T15:37:27Z-
dc.date.issued2011-10-28en_GB
dc.date.accessioned2011-10-28T15:37:27Z-
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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