Beliefs About Hospital Diabetes and Perceived Barriers to Glucose Management Among Inpatient Midlevel Practitioners

Cook, Curtiss B.; Jameson, Kimberly A.; Hartsell, Zachary; Boyle, Mary E.; Leonhardi, Brenda J.; Farquhar-Snow, Marci; Beer, K

doi:10.1177/0145721707311957

Cited by 57 publications

(53 citation statements)

References 25 publications

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“…22 In a study exploring attitudes and selfreported barriers to glucose management among midlevel providers, researchers reported that 39% were unsure of the best way to treat hyperglycemia and 22% were unsure when to start an insulin infusion. 23 The need for ongoing education on glycemic control in critical illness was identified by the critical care clinical nurse specialist (CNS)/project lead on the basis of a review of the literature, requests for ongoing education on diabetes management from nurses on program evaluations, and compliance with SCIP-Inf-4.…”

Section: Knowledge Deficit Regarding Glycemic Controlmentioning

confidence: 99%

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Hargraves

2014

American Journal of Critical Care

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Background Acute hyperglycemia following cardiac surgery increases the risk of deep sternal wound infection, significant early morbidity, and mortality. Insulin infusion protocols that target tight glycemic control to treat hyperglycemia have been linked to hypoglycemia and increased mortality. Recently published studies examining glycemic control in critical illness and clinical practice guidelines from professional organizations support moderate glycemic control. Objectives To measure critical care nurses' knowledge of glycemic control in cardiac surgery before and after education. To evaluate the safety and effectiveness of an evidence-based insulin infusion protocol targeting moderate glycemic control in cardiac surgery patients. Methods This evidence-based practice change was implemented in the cardiovascular unit in a community teaching hospital. Nurses completed a self-developed questionnaire to measure knowledge of glycemic control. Blood glucose data, collected (retrospectively) from anesthesia end time through 11:59 PM on postoperative day 2, were compared from 2 months before to 2 months after the practice change. Results Nurses' knowledge (test scores) increased significantly after education (pretest mean = 53.10, SD = 11.75; posttest mean = 79.10, SD = 12.02; t 54 = -8.18, P < .001). Mean blood glucose level after implementation was 148 mg/dL. The incidence of hypoglycemia, 2.09% before and 0.22% after the intervention, was significantly reduced ( 2 1 [n = 29] = 13.9, P < .001). The percentage of blood glucose levels less than 180 mg/dL was 88.30%. Conclusions Increasing nurses' knowledge of glycemic control and implementing an insulin infusion protocol targeting moderate glycemic control were effective for treating acute hyperglycemia following cardiac surgery with decreased incidence of hypoglycemia.

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Section: Knowledge Deficit Regarding Glycemic Controlmentioning

confidence: 99%

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Hargraves

2014

American Journal of Critical Care

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“…6 This inconsistency in recommended glucose targets may partially explain the variation in glucose goals practiced by different hospitals across the United States. 7 Additionally, neither individual practitioners [38][39][40][41] nor hospitals 7 have standardized definitions for biochemical hypoglycemia. These standards should be established before implementation of a national benchmarking process.…”

Section: Which Glucose Ranges Should Hospitals Be Targeting?mentioning

confidence: 99%

Assessing Inpatient Glycemic Control: What are the Next Steps?

Cook¹,

Wellik

Kongable

et al. 2012

J Diabetes Sci Technol

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Abbreviations: (POC-BG) AbstractDespite the emergence of glucometrics (i.e., systematic analysis of data on blood glucose levels of inpatients) as a subject of high interest, there remains a lack of standardization on how glucose parameters are measured and reported. This dilemma must be resolved before a national benchmarking process can be developed that will allow institutions to track and compare inpatient glucose control performance against established guidelines and that can also be supported by quality care organizations. In this article, we review some of the questions that need to be resolved through consensus and review of the evidence, and discuss some of the limitations in analyzing and reporting inpatient glucose data that must be addressed (or at least accepted as limitations) before hospitals can commit resources to gathering, compiling, and presenting inpatient glucose statistics as a health care quality measure. Standards must include consensus on which measures to report, the unit of analysis, definitions of targets for hyperglycemia treatment, a definition of hypoglycemia, determination of how data should be gathered (from chart review or from laboratory information systems), and which type of sample (blood or point of care) should be used for analysis of glycemic control. Hospitals and/or their representatives should be included in the discussion. For inpatient glucose control to remain a focus of interest, further dialogue and consensus on the topic are needed.

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“…2 Finally, surveys of inpatient practitioners confirm a lack of familiarity with the use of insulin pumps. [3][4][5][6] Thus inpatient physicians may justifiably struggle with whether to allow CSII users to continue their therapy during a hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Outpatient-to-Inpatient Transition of Insulin Pump Therapy: Successes and Continuing Challenges

Nassar

Partlow

Boyle

et al. 2010

J Diabetes Sci Technol

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Beliefs About Hospital Diabetes and Perceived Barriers to Glucose Management Among Inpatient Midlevel Practitioners

Abstract: Most midlevel providers acknowledged the importance of good glucose control in the hospital. Lack of familiarity with how to use insulin in the hospital was the most commonly cited barrier to care. Educational programs should heavily emphasize inpatient treatment strategies.

Cited by 57 publications

References 25 publications

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Glycemic Control in Cardiac Surgery: Implementing an Evidence-Based Insulin Infusion Protocol

Assessing Inpatient Glycemic Control: What are the Next Steps?

Outpatient-to-Inpatient Transition of Insulin Pump Therapy: Successes and Continuing Challenges

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