ppt课件-inpatient glycemic control（住院病人血糖控制）.pptVIP

Inpatient Glycemic Control Sherry Buske RN, MSN,NP-C, CDE April 2010 UNDERSTANDING THE CURRENT STATE Lack of A1C Inconsistent patient education Lack of coordination of BG testing, meals, insulin administration Inconsistent treatment of hyperglycemia Insulin use: Sliding scale 83% Basal bolus 10% NPH/split mixed 7% RESTRAINING FORCES Lack of knowledge Concern of time involved Increased monitoring Counting carbs Basal bolus insulin Fear of hypoglycemia RESTRAINING FORCES (cont) Timing: Any other big changes (Care Cast) How long will change take Time of year (summer and vacations) INTERDISCIPLINARY GLYCEMIC STRATEGY TEAM Needs: Executive Leadership Medical Champion(s) Nursing Champion(s) IMPLEMENTING A SUCCESSFULINPATIENT GLYCEMIC CONTROL PROGRAM Requires: Interdisciplinary advisory committee to develop and guide ALL initiatives related to glycemic control Full time RN, CDE IMPLEMENTING A SUCCESSFULINPATIENT GLYCEMIC CONTROL PROGRAM (cont) Designated champion(s) Quality department support Referrals to Home Health and Outpatient Diabetes Center at discharge IMPLEMENTING A SUCCESSFULINPATIENT GLYCEMIC CONTROL PROGRAM Development and implementation of new or revised interventions Standardized order sets Protocols Policies Algorithms Initial ongoing staff education to follow above Metrics: Recognized Targets, Review GPOC (glucose point of care) data TRMC’s Glycemic Management Campaign AIM: Improve glycemic control of the inpatient with diabetes or hyperglycemia without causing hypoglycemia 80% of the point of glucoses will be between 100 and 180 in CCU. 80 % of the point of care glucose will be between 100 and 180 on our medical/surgical areas. Keep hypoglycemic episodes at or below 4% house wide AIM (cont) The aim will be accomplished through: 1. Active surveillance 2. Using standardized evidence based order sets and protocols supported by the American Diabetes Association (ADA), the American Association of Endocrinologists (AACE) and/or America