Quality Improvement on Hyperglycemia

Quality Improvement on Hyperglycemia

Cook, C., Elias, B., Kongable, G., Potter, D., Shepherd, K., & McMahon, D. (2011). Diabetes and Hyperglycemia Quality Improvement Efforts in Hospitals in the United States: Current Status, Practice Variation, and Barriers to Implementation. Endocrine Practice.

In a healthcare environment, nurses frequently interact with the patients, healthcare professionals and the family member of the ailing individuals. Most of the times, they are they are among the first to receive notification of the emergency conditions of patients. However, the hospital policies require nurses to await doctor’s assessment prior to responding to patient’s condition including those they can handle like hypo/hyperglycemia. Studies indicate that if hypo or hyperglycemia is not treated in time, chances are that the patient will die. To minimize the fatality rate due to hyper/hypoglycemia, Cook et al. (2011) propose quality improvement in provision of medical treatment by allowing nurses to respond to reported cases. Detection of hyperglycemia should result in an immediate response from the nurses through the administration of dextrose and dextrosol tablets.

            According to Cook et al. (2011), hypoglycemia is a condition that results from the blood glucose falling below 70mg/dL. It is a common occurrence for hospitalized patients suffering from Diabetes Mellitus. The causes of hypo/hyperglycemia include medications, missed meals, interruption of tube feeds and nil-by-mouth status. Some of the symptoms associated hypo/hyperglycemia includes coma, convulsions, confusion, sweating, and hunger. The more severe the case of hypo/hyperglycemia, the greater the fatality risk.  For elderly patients, instances of hypo/hyperglycemia increase with the length of hospital stay (LHS). While hyperglycemia is common for older patients, the mortality rate is higher too, which begs for the introduction of measures to allow nurses to treat the disease promptly. If hyper/hypoglycemia is aggressively detected and managed, a diabetic patient will save in medical expenses. In addition, the physician will spend less time to address the case and the mortality rate as a result of this disease will be minimized greatly. Considering this, the hospital should invest on nurse-initiated hyper/hypoglycemia treatment (NHT).

The implementation process of NHT without the order of a physician entails extensive planning. First, the nurses and the organization should not be hesitant to embrace change for quality improvement in service delivery.  The nursing staff should also receive adequate training on the new process, which calls for the allocation of resources by the hospital management. The safety of NHT can be ensured by initiation of HTP (hypo/hyperglycemia treatment protocol). HTP improves the quality of treatment of hyper/hypoglycemia patient by inhibiting the deterioration of patient’s condition. Besides, the protocol defines the role of a caregiver to direct them towards safe practice.  Success in NHT cannot be achieved unless the nurses seek advice from experienced diabetic specialists, endocrinologists and dieticians. Furthermore, HTP should be detailed in its definition on the type of medication and treatment to administer as per the patient’s condition.

Moreover, the nurse should collect data on the rising issues, effectiveness, and the cost incurred in hyper/hypoglycemia treatment. The information such as this is crucial especially in the analysis and comparison of NHT benefits and the anticipated cost of the project. The nurses’ regulatory body and the government should be involved in the project design process to increase the scope of nursing practice. NHT calls for a revision of nursing standards for improvement of service delivery and patient care.

Before NHT can be implemented, it is important to test the safety and benefits of the program. Therefore, a pilot program should be conducted in a general vascular surgery and medical unit (mostly has a high number of diabetic patients) due to the high prevalence of hyper/hypoglycemia (Ramos et al., 2012). A successful execution of the pilot program means that NHT can be adopted in other departments of the medical facilities countrywide. However, periodic assessment ought to be conducted to determine and improve the quality of patient care through NHT. Moreover, a clinical manager should conduct in-hospital education on HTP and hypo/hyperglycemia to inform the nurses and physicians on the scope of the project. For the participating wards, the hospital’s management should avail resources for the team leaders to provide guidance, encouragement, and support.

Implementation of NHT to improve the quality of care to hypo/hyperglycemia patients is challenging because of a possible resistance to change. Fist, the nurses can resist participating in NHT practice to avoid shifting away from a comfort zone. Therefore, assisting the staff in the adoption process is crucial to ensure the success of the project. Over time, the caregivers are familiarized with the practice, resulting in diminishing resistance and an improvement of the quality of care accorded to hyper/hypoglycemia patients (Osburne et al., 2012). Still, motivating the NHT team is necessary to prevent instances of negative attitudes that can jeopardize the exercise thus leading to unfavorable outcomes. Furthermore, given the strict regulations in the health ministry, obtaining approval from the regulatory organ can be a strenuous task. However, the government should weigh the disadvantages against advantages and endorse the practice as per the potential benefits.

In summary, hypo/hyperglycemia is a life-threatening condition, especially if not treated in time. However, caregivers can treat the disease if accorded with adequate guidance and training. In this way, the quality of care for the patients is boosted. Notably, the implementation process of NHT is an uphill task, hence a need to prevent the cases of hypo/hyperglycemia.

References

Cook, C., Elias, B., Kongable, G., Potter, D., Shepherd, K., & McMahon, D. (2011). Diabetes and Hyperglycemia Quality Improvement Efforts in Hospitals in the United States: Current Status, Practice Variation, and Barriers to Implementation. Endocrine Practice.

Osburne, R.C., Cook, C.B., Stockton, L., Baird, M., Harmon, V., Keddo, A., Pounds, T., Lowey, L., Reid, J., McGowan, K.A. and Davidson, P.C., 2006. Improving Hyperglycemia Management in the Intensive Care Unit Preliminary Report of a Nurse-Driven Quality Improvement Project Using a Redesigned Insulin Infusion Algorithm. The Diabetes Educator, 32(3), pp.394-403.

Ramos, M., Khalpey, Z., Lipsitz, S., Steinberg, J., Panizales, M.T., Zinner, M. and Rogers, S.O., 2012. Relationship of Perioperative Hyperglycemia and Postoperative Infections in Patients Who Undergo General and Vascular Surgery. Annals of surgery, 248(4), pp.585-591.