Sara Cohen, MSN, RN, Barbara Morrison, MSN, RN, and Kelly Milligan, CRNP
Pennsylvania Hospital, Penn Medicine
When Sara Cohen, MSN, RN, began working at Pennsylvania Hospital supporting the nighttime staff, she recognized that care for patients with diabetes did not follow appropriate practice recommendations. Sliding scale insulin was not being given at bedtime, the timing of insulin administration throughout the day was not within the care guidelines, and there was a general tendency toward permissive hyperglycemia—liberal management of high glucose levels in patients. Staff also had a general gap in knowledge about the actions and timing of insulin, and how sliding scale coverage differs from basal bolus dosing.
Cohen worked closely with Barbara Morrison, outpatient diabetes educator, to better understand the guidelines staff should be following. Over the past two years they audited hundreds of charts; provided shoulder-to-shoulder education to staff; enhanced hospital guidelines around care of patients with diabetes; and created a comprehensive, mandatory, online learning module for all staff covering diabetes, insulin action, and best practices related to caring for these patients. They also created a diabetes task force to elicit participation from staff on all units, share the steps in caring for patients with diabetes, and help with chart audits to track compliance.
Cohen also collaborated with others to develop a daytime and nighttime education grand rounds in November about the new guidelines, the reasons for this initiative, and in-depth information about diabetes and the risks associated with practicing permissive hyperglycemia. The facility's bedtime sliding scale insulin administration compliance is now at 98% (up from 34%), and staff is now tracking charts for improved timing of insulin and blood glucose results, and improved documentation around insulin administration.
This two-year process resulted not only in enhanced knowledge and appropriate practices for staff, but also, most importantly, improved care that so many patients will receive while they are admitted to the hospital.