Purpose: The purpose of this initiative was to implement an evidence based process to improve BG control by coordinating BG testing, administration of insulin and delivery of meals in patients with fast/rapid acting insulin orders.
Methods: Multidisciplinary taskforce formed by Nursing Leaders, Nutrition Services Leaders, Clinical Educators, Clinical RNs and Certified Diabetes Educator met at the beginning of 2016 to evaluate current practice (room service) and recommend changes. 3 South was selected to pilot the new process in June of 2016. Pharmacy provided Nutrition Services with a list of patients taking insulin. Specific times were stablished to deliver diabetes meal trays to the nursing unit, to test BG and to administer insulin. If the BG test was performed more than 60 minutes before the fast/rapid acting insulin injection was due, the test was repeated. RN/CP served meal as soon as insulin was administered. Process was extended to other Med/Surge units in 3 month increments over the following 6 months.
Results: Prior to starting intervention, 83% of BG readings were at target (60 – 200 mg/dl). After completing intervention 91% of BG readings were at target.
Discussion: Coordination of blood glucose testing, insulin administration and delivery of meals is crucial in the safe and effective care of patients with diabetes/hyperglycemia. BG monitoring is used to guide insulin dosing. In patients who are eating, the timing of BG testing should closely match insulin administration and meal intake to prevent over and under dosing, which could lead to hypo or hyperglycemia. Through inter-professional teamwork, communication and targeted staff education, a new practice was stablished supporting timely care and improved patient outcomes.
13th Annual BHSF Research Conference
Gough, Maria and Geneve, Margaret, "Coordination of BG testing, Insulin Administration and Delivery of Meal Trays" (2018). All Publications. 2829.
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