Hospital Acquired Hypo/Hyperglycemia: A Clinical Issue

2.50
Hdl Handle:
http://hdl.handle.net/10755/624079
Category:
Full-text
Format:
Text-based Document
Type:
DNP Capstone Project
Level of Evidence:
Clinical Practice Guideline(s)
Research Approach:
Pilot/Exploratory Study
Title:
Hospital Acquired Hypo/Hyperglycemia: A Clinical Issue
Author(s):
Hughes, Lucille
Advisors:
Moore, Kate; Saathoff, Angela
Abstract:

Hypo- and hyperglycemia related to improper timing of mealtime insulin occurs frequently in the in-patient setting. The timing of mealtime insulin administration is affected by many variables such as blood glucose meter availability, meal delivery and patient’s willingness and desire to eat. The purpose of this collaborative multidisciplinary evidence-based project was to improve the timing of mealtime insulin administration related to point of care fingerstick blood glucose monitoring and meal delivery to decrease the rate of hypo- and hyperglycemia. The average time between point of care fingerstick blood glucose monitoring and insulin delivery on the medical unit where this project was conducted was 57.44 minutes. In addition, mealtime insulin administration was not consistently documented, and timing between meal tray delivery and mealtime insulin administration was not a documented task.  The John Hopkins Nursing Evidence-based Practice Model served as the conceptual framework for the project, and the use of the Six Sigma Methodology served as the practice method.  The findings or this project proved food delivery notification enabled the nursing staff to efficiently administer mealtime insulin in coordination with point of care fingerstick blood glucose monitoring and the delivery of meals.  In addition, 100% of point of care fingerstick blood glucose monitoring was administered within the best practice window of 30 minutes, 100% of mealtime insulin administration was documented, and 76% of patients received mealtime insulin within the recommended 15-minute window.  Secondary outcome metrics of reducing rates of hypo/hyperglycemia by 10% was achieved for recurring hypoglycemia; however, hyperglycemia rates remained unchanged.

Keywords:
mealtime insulin; prandial insulin administration; hypo/hyper glycemia; Nutritional Insulin; Inpatient; Coordinated Mealtime Insulin Delivery; Coordinated Meal Delivery
CINAHL Headings:
Inpatients; Hospitalization; Hyperglycemia--Prevention and Control; Hypoglycemia--Prevention and Control; Hypoglycemic Agents--Administration and Dosage; Glycemic Control; Insulin--Administration and Dosage; Blood Glucose--Analysis; Meals; Hyperglycemia; Hypoglycemia; Hypoglycemic Agents; Insulin
Repository Posting Date:
2-Apr-2018
Date of Publication:
2-Apr-2018
Note:
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Grantor:
Capella University
Degree:
DNP
Degree Year:
2018

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typeDNP Capstone Projecten
dc.evidence.levelClinical Practice Guideline(s)en
dc.research.approachPilot/Exploratory Studyen
dc.titleHospital Acquired Hypo/Hyperglycemia: A Clinical Issueen_US
dc.contributor.authorHughes, Lucilleen
dc.contributor.advisorMoore, Kateen
dc.contributor.advisorSaathoff, Angelaen
dc.identifier.urihttp://hdl.handle.net/10755/624079-
dc.description.abstract<p>Hypo- and hyperglycemia related to improper timing of mealtime insulin occurs frequently in the in-patient setting. The timing of mealtime insulin administration is affected by many variables such as blood glucose meter availability, meal delivery and patient’s willingness and desire to eat. The purpose of this collaborative multidisciplinary evidence-based project was to improve the timing of mealtime insulin administration related to point of care fingerstick blood glucose monitoring and meal delivery to decrease the rate of hypo- and hyperglycemia. The average time between point of care fingerstick blood glucose monitoring and insulin delivery on the medical unit where this project was conducted was 57.44 minutes. In addition, mealtime insulin administration was not consistently documented, and timing between meal tray delivery and mealtime insulin administration was not a documented task.  The John Hopkins Nursing Evidence-based Practice Model served as the conceptual framework for the project, and the use of the Six Sigma Methodology served as the practice method.  The findings or this project proved food delivery notification enabled the nursing staff to efficiently administer mealtime insulin in coordination with point of care fingerstick blood glucose monitoring and the delivery of meals.  In addition, 100% of point of care fingerstick blood glucose monitoring was administered within the best practice window of 30 minutes, 100% of mealtime insulin administration was documented, and 76% of patients received mealtime insulin within the recommended 15-minute window.  Secondary outcome metrics of reducing rates of hypo/hyperglycemia by 10% was achieved for recurring hypoglycemia; however, hyperglycemia rates remained unchanged.</p>en
dc.subjectmealtime insulinen
dc.subjectprandial insulin administrationen
dc.subjecthypo/hyper glycemiaen
dc.subjectNutritional Insulinen
dc.subjectInpatienten
dc.subjectCoordinated Mealtime Insulin Deliveryen
dc.subjectCoordinated Meal Deliveryen
dc.subject.cinahlInpatientsen
dc.subject.cinahlHospitalizationen
dc.subject.cinahlHyperglycemia--Prevention and Controlen
dc.subject.cinahlHypoglycemia--Prevention and Controlen
dc.subject.cinahlHypoglycemic Agents--Administration and Dosageen
dc.subject.cinahlGlycemic Controlen
dc.subject.cinahlInsulin--Administration and Dosageen
dc.subject.cinahlBlood Glucose--Analysisen
dc.subject.cinahlMealsen
dc.subject.cinahlHyperglycemiaen
dc.subject.cinahlHypoglycemiaen
dc.subject.cinahlHypoglycemic Agentsen
dc.subject.cinahlInsulinen
dc.date.available2018-04-02T18:14:27Z-
dc.date.issued2018-04-02-
dc.date.accessioned2018-04-02T18:14:27Z-
dc.description.noteThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.-
thesis.degree.grantorCapella Universityen
thesis.degree.levelDNPen
thesis.degree.year2018en
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