Factors Associated With Timely Blood Glucose Testing and Insulin Administration in Patients Receiving Mealtime Insulin Coverage in Medical Surgical Units

Abstract

Purpose The purpose of the study was to identify the rate and factors associated with timely mealtime capillary blood glucose (CBG) testing and insulin coverage in hospitalized patients with diabetes. Methods A descriptive-correlational design was used with a random sample of patients (n = 77) and nurses (n = 36) on a medicine and a neuroscience unit of a large Magnet hospital. After written consent was obtained, post-meal patient and nurse interviews were conducted to collect information about patient, nurse, and situational factors known to influence timely mealtime diabetes care. Results Timely CBG testing occurred on 85.7% of the patient participants, and 71.4% received timely insulin coverage. Timely CBG testing was associated (unadjusted) with telling the patient care associate to obtain a finger stick (FS) prior to meals and patient off the unit during mealtime. The odds of having insulin administered on time was significantly and independently associated with the nurse caring for fewer patients, patients waiting for insulin prior to eating, and patients knowing pre-meal FS was high. Conclusions One situational factor and 2 patient factors were independently associated with timely insulin coverage prior to meals. Interventions aimed at raising staff awareness of these factors and providing tailored education to patients may improve the odds of having insulin administered on time.

Improving time intervals of blood glucose levels and insulin : the best practice bundle

“…Literature Review An extensive review of the literature was conducted about the timing of POC-BG and increasing compliance with a shorter timeframe. Some articles discussed barriers such as high nurse-to-patient ratios, patients not knowing to wait to eat until their blood glucose was checked, poor team member communication, patients being off unit when meals are delivered, a "dining on call system" where patients call for trays at various times, competing priorities of patient care, and convenience POC-BG testing such as during vitals or other rounds rather than specific to mealtime (Dungan, 2019;Kaisen, Parkosewich, & Bonito, 2018). Articles by Engle, Ferguson, & Fields, 2016;Eichmiller, Horner, & Sanjurjo, 2019;Thomas et al, 2022;and Hughes and Caragher, 2021 all discussed the improved glycemic control with a shorter POC-BG to insulin administration interval.…”