Hospitalized patients can have inconsistent nutritional intake due to acute illness, changing diet, or unpredictable meal delivery. The aim of this study was to evaluate whether implementation of a hospital-wide policy shifting nutritional insulin administration from pre-meal to post-meal was associated with changes in glycemic control or length of stay (LOS). 

Effects of preprandial versus postprandial nutritional insulin administration in the inpatient setting

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.

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

To examine the effectiveness of a comprehensive diabetes education class on improving nurses' self-efficacy in glycemic management and physician communication, with a focus on using the SMILE (Sugar Trend, Medications, Intravenous Fluid, Labs, and Eating) SBAR (Situation, Background, Assessment, Recommendation) as a communication tool. The secondary aim of this study was to investigate the translation of knowledge into practice, in this case, inpatient glycemic control. Inpatient glycemic management for patients living with diabetes can be challenging. Therefore, as patient advocates, nurses must be able to identify what clinical data warrants a call to the physician to facilitate timely decisions and interventions. Data was collected from a convenience sample of 28 registered nurses from a single general medicine unit. A t-test was used to analyze nurses' pretest-posttest perceptions of self-efficacy in nine content areas. Kruskal-Wallis H analysis was also conducted on patients' median blood glucose values over four months (July–October 2023). The results suggest the class was effective in improving nurses' perceived knowledge and self-efficacy in all nine content areas, with the highest mean difference increase of 1.46 for I have sufficient knowledge regarding the SMILE SBAR and [will]use it as a tool for communicating with the physician, p < 0.05. A comparison of 403 patients' median blood glucose values were also statistically significantly different across four months, χ2(3) = 21.088, p < 0.0001. Continued efforts to prevent and manage inpatient glycemic control should focus on enhancing nurse-physician communication and teamwork with simple yet effective tools such as the SMILE SBAR. 

Enhancing inpatient glycemic education and management with a SMILE SBAR: A quantitative study

Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort to reduce iatrogenic insulin-associated hypoglycemia at the University of Chicago Medical Center in Chicago, IL.

Reducing Inpatient Hypoglycemic Events: A Focus on Mealtime Insulin.

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Reducing Inpatient Hypoglycemic Events: A Focus on Mealtime Insulin.