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

Abstract

Nature and scope of the project: Proper diabetes management for patients in a hospital setting is critical due to their high propensity for co-morbidities (Kansas Department of Health and Environment, 2019). Dosing insulin off real-time blood glucose levels prevents hypo and hyperglycemic events (ADA, 2024). The purpose of this project is to decrease the time interval between the point-of-care blood glucose (POC-BG) and insulin administration on hospitalized patients by following a nursing bundle. The primary outcome variable was insulin administrations ?15 minutes from the POC-BG. Synthesis and analysis of supporting literature: The American Diabetes Association recommends hospitalized receive their blood glucose check, insulin administration, and coordinated with their meal when applicable. A nurse driven bundle was developed to improve the timing between the POC-BG and insulin administration. Project implementation: To increase compliance with the best practice bundle, the existing bundle was modified and reintroduced in December 2023 and POC-BG to insulin administration time intervals were measured in T1- January 2024 and T2- February 2024. Evaluation criteria: Pre-intervention compliance rates were measured, interventions were completed, and evaluation of the POC-BG to insulin administration times were measured with a goal of 75 percent being ?15 minutes in T1 and T2 on two separate units. Outcomes: There were 446 instances measured from 146 patients on the two units over T1 and T2. The CCU increased their compliance from pre-intervention level of 72.6 percent to T1-82.1 percent, and T2-86.2 percent. The primary objective was achieved on this unit. The HNVU increased their compliance from a pre-intervention level of 34.4 percent to T1-52.3 percent and T2-43.1 percent. Although their compliance has improved from baseline, they did not achieve the primary objective of 75 percent. Recommendations: This pilot project will continue at this site by expanding to other units. In the expansion, the data from this project will help guide the implementation of this bundle by recognizing target areas that are prone to not meeting goals. Research should also continue, when possible, in evaluating the number of hypo and hyperglycemic events in the pre and post pilot periods to measure if the bundle does affect glucose variability.