Hospital Acquired Hypo/Hyperglycemia: A Clinical Issue

Abstract

<p>Hypo- and hyperglycemia related to improper timing of mealtime insulin occurs frequently in the in-patient setting. The timing of mealtime insulin administration is affected by many variables such as blood glucose meter availability, meal delivery and patient’s willingness and desire to eat. The purpose of this collaborative multidisciplinary evidence-based project was to improve the timing of mealtime insulin administration related to point of care fingerstick blood glucose monitoring and meal delivery to decrease the rate of hypo- and hyperglycemia. The average time between point of care fingerstick blood glucose monitoring and insulin delivery on the medical unit where this project was conducted was 57.44 minutes. In addition, mealtime insulin administration was not consistently documented, and timing between meal tray delivery and mealtime insulin administration was not a documented task. The John Hopkins Nursing Evidence-based Practice Model served as the conceptual framework for the project, and the use of the Six Sigma Methodology served as the practice method. The findings or this project proved food delivery notification enabled the nursing staff to efficiently administer mealtime insulin in coordination with point of care fingerstick blood glucose monitoring and the delivery of meals. In addition, 100% of point of care fingerstick blood glucose monitoring was administered within the best practice window of 30 minutes, 100% of mealtime insulin administration was documented, and 76% of patients received mealtime insulin within the recommended 15-minute window. Secondary outcome metrics of reducing rates of hypo/hyperglycemia by 10% was achieved for recurring hypoglycemia; however, hyperglycemia rates remained unchanged.</p>