As the popularity for insulin pump therapy to manage diabetes rises, the hospital setting is bound to acquire these patients. Currently there is not consensus among diabetes organizations, or guidelines from accrediting bodies on how to safely care for this patient population while in the hospital. Therefore, health care professionals in the hospital may struggle with how to best manage the insulin pump patient. To address this issue, a quality improvement program was designed to standardize insulin pump management. The primary aims were to reduce practice variation, promote safety, and optimize compliance and outcomes within this clinical setting. The nurse-designed program components are highly-structured and consist of policies, a contract, a competency, an order set, and specialty training for insulin pump resource nurses. This presentation will discuss system-wide steps for implementing this type of program, barriers to overcome, as well as explore successes toward achieving optimal outcomes.
Due to reduced funding for education from recent economic pitfalls, school districts have had to restructure, as well as reduce staff members. This change has had significant impact the on the availability of school nurses to assist children with diabetes care. Success in the management of diabetes in this population seems to be derived from strong support networks, both at home and at school. Diabetes educators have the unique opportunity to help schools effectively deal with the shortage of nursing personnel within the school system by contributing to the management of children with diabetes. An example of this is the training of volunteers in school systems to assist with care and management practices. This presentation will highlight such a program, from development to implementation, and provide participants with tools intended to foster that essential partnership between schools and experts in diabetes management.
Advocacy Guide: Reauthorization of the Special Diabetes Program for Indians (SDPI) - How Can Diabetes Educators Reach Native American Communities?Nationally and locally, Native American communities around the country are working through the Awakening the Spirit Team to encourage Congress to continue funding diabetes education programs in tribal communities.Writing, faxing, calling and visiting congressional members are several strategies employed at the community level to lobby for issues of concern specifically addressing needs identified by the Native American community.The volunteer leadership of the American Diabetes Associaiton's Native American Subcommittee (Awakening the Spirit), representing over 500 American Indians and Alaska Native communities, invites you to advocate locally and nationally for increased access to diabetes education in Native American communities. Visit the Poster Session to see the new Advocacy Guide developed by the Awakening the Spirit national volunteer team of Native Americans.
Diabetic retinopathy (DR) is the leading cause of blindness among working age adults. DR is a progressive eye complication. Early detection and treatment are crucial in reducing blindness. The following survey was done to identify the barriers against meeting the ADA recommendations for DR screening. A total of 133 diabetes patients participated in this survey. Results showed that 35.4% of the patients reported eye problems that include cataract, glaucoma, DR, and others. 53.4% of the patients reported they had an annual dilated eye exam. Less than 50% of the patients learned about DR from their physicians or diabetes educators. Barriers preventing patients from seeking screening include knowledge deficit, cost, and patient’s perception of procedure as unnecessary. Our results suggest a need for diabetes educators and physicians to explain the importance of screening for DR. Results also suggest that affordable, convenient screening programs are necessary for the uninsured population with diabetes.
Several clinical trials indicate that hyperglycemia is associated with poor patient outcomes such as impaired wound healing, increased risk of infection, increased length of stay, and increased mortality. In an effort to improve glycemic control, different strategies are available for hyperglycemia management in hospitalized patients with diabetes. Clinical evidence indicates that a standard of practice for treating non-critically ill hospitalized patients with hyperglycemia or diabetes is through a Basal – Bolus subcutaneous insulin therapy approach. This standard of Basal-Bolus practice, which imitates what a “normal” pancreas does, is the focus of SubQ insulin therapy used to treat non-critically ill patients with hyperglycemia or diabetes at Shands Jacksonville Medical Center (SJMC) in Jacksonville, Florida. Through review of orders for this type of therapy and clinical inpatient scenarios, participants will experience how one major teaching hospital has put it into practice.
Studies indicate that inpatient nurses have knowledge deficits regarding diabetes management and patient education, and they lack confidence in providing the necessary education in the hospital setting. The evidence shows that cardiac patients have numerous co-morbid conditions, including type 2 diabetes, and they often have suboptimal management. The purpose of this diabetes quality improvement (QI) project is to identify the diabetes knowledge and confidence levels of nurses caring for cardiac patients with hyperglycemia and diabetes. The objectives of the project are to assess the nurses’ level of diabetes knowledge and attitudes in providing patient education, to provide a unit-based training program, and to re-assess the knowledge and attitudes of the nurses. The methodology includes the use of a pre/post diabetes knowledge test and diabetes attitude survey developed by the University of Michigan Diabetes Research and Training Center. The outcomes will demonstrate staff competency and the impact on patient follow up.
Insulin pumps use in the community continues to grow and therefore hospitals should plan to see more patients admitted wearing an insulin pump. Because of the nature of pump therapy, the safety of the infusion is in large part the patient or family's responsibility. Nurses as the frontline caregivers,are often found in a dilema how to handle these patient needs while hospitalized with a limited working knowledge of insulin pump therapy. Having a standardized order set and policy for insulin pumps inpatient usage will assist the nurse in her role to provide safe patient care as well as allow the patient to continue the best treatment for their diabetes.
Diabetes is often associated with significant acute and chronic complications. However, it holds a very close relationship with heart disease. When heart disease teams up with diabetes, challenging statistics show that patients with diabetes have a greater incidence of hospitalization, morbidity and mortality, and greater risk for suffering a stroke. Evidenced based research shows that early and optimal glycemic control and treatment options improve outcomes in patients with acute myocardial infarction, stroke/transient ischemic attack, percutaneous angioplasty, coronary stent placement and coronary artery bypass. Through stimulating discussion and analysis of inpatient clinical cases, participants will discover that any patient admitted to the hospital with hyperglycemia or diabetes and one of the diagnoses noted can benefit from best practice glycemic management and therapeutic options.
The number, type and kinetics of diabetes medications have exploded over the past few years. Unfortunately the dietary prescription for diabetes has not keep up with the numerous new medications and their unique properties. The traditional dietary prescription for diabetes included 3 meals with an evening snack or 6 small meals spread throughout the day. These traditional diets are no longer necessary, depending on the diabetes medication, and in fact if prescribed with certain medication combinations could cause worsening in diabetes control. It is important for the diabetes educator to have an in depth knowledge of the kinetics of the patients' diabetes medication and to be able to discuss with the patient, based on their prescribed medication ,the most appropriate diet that will allow the patient to achieve diabetes control
This is a multidisciplinary improvement project to coordinate meal delivery, blood glucose testing, and insulin delivery. The process included education, communication, and process changes in Food/Nutrition, Pharmacy, and Nursing departments. Education on insulin analogues, importance of consistent meal times, and reliable glucose timing was hospital wide. The Food/Nutrition associates modified their meal delivery process to meet consistent delivery times and included priority delivery of consistent carbohydrate trays. Pharmacy changed insulin administration to reflect meal times. Blood glucose testing would be no sooner than thirty minutes before meals. Food/Nutrition and Nursing shared accountability to confirm meal delivery time. Nursing developed standard operating procedures and checklists for consistent patient education. The hospital reduced the cost of the outpatient class and the Maury Regional Foundation agreed to give financial assistance for those who qualify. Hypoglycemia decreased 35%, readmission for primary diagnosis of diabetes dropped from 19% to 0%, outpatient class attendance increased 41%.
Successful management of diabetes requires the achievement of all AADE7 Self-Care Behaviors including 'Healthy Coping' and 'Taking Medications.' The attitude of denial affects healthy coping and can be a significant obstacle to appropriate diabetes self-management, including the initiation or maintenance of an insulin regimen.The focus of this study is to determine the prevalence, among inpatients, of expressed denial regarding their need for insulin and to identify the tools toward overcoming this behavioral issue.
Tight glycemic control yields clinical benefits in patients with diabetes. This poster describes a protocol for maintaining tight glycemic control in subjects with type 1 diabetes in a Phase 3 study (DEFEND-1). 272 subjects received 8 days of otelixizumab or placebo. A protocol to support tight glycemic control included intensive insulin therapy, providing glucose monitoring strips, monthly visits with HbA1c measurement and targeting 6%, and calls from the sponsor to investigative sites requesting follow-up when HbA1c was 7.0% or higher. Of 272 dosed subjects, 56% had an HbA1c >7%. Currently, 114 subjects have reached the Month 12 time point with a total of 1,332 HbA1c values. The study-wide HbA1c average at Month 12 was 6.9% (N=111); 58% of subjects had an HbA1c <7%, of which 37.5% had an HbA1c <6.0%. Additional metrics regarding contacts to investigative sites and case studies where the sponsor has funded nutritional/diabetic counseling will be presented.