Question

review treatment protocols for hyperglycemia?

Answer 1

The protocol was developed to achieve standardization of care for patients with hyperglycemia who are admitted to medical wards. Based on the joint work of physicians and nurses, it confers authority for glucose management decisions on RNs and defines appropriate interaction among nurses, physicians, and other health care team members. Specifically, the protocol aimed to:

• Increase the quality of care of patients with diabetes hospitalized in medical wards

• Establish uniformity of treatment for patients with diabetes hospitalized in medical wards

• Achieve improved glucose control through regimens that are individualized to meet the specific needs of each patient and accepted by all involved clinicians

• Build a mutual basis of knowledge for nursing and medical staff members concerning diabetes management, treatment, and education

• Establish the responsibility and instill the commitment of nurses for managing patients' glucose levels

Toward that end, the protocol includes the project's background and aims; definition of terms; delineation of the authority and responsibilities of RNs and primary physicians; definition of the target population and exclusion criteria for use of the protocol; description of the treatment procedure and regimen; and guidelines for nurse training, reporting, and patient discharge. The following sections provide details on the principles contained in the protocol.

Glucose control regimen

1. The initial order must be given by patients' primary physician at the time of admission.

2. The method of treatment is based on a basal-bolus insulin regimen, taking into consideration the different types of insulin available.

3. The ordered regimen must include determination of a glucose target range (either 110–180 mg/dl or as defined otherwise by the physician).

4. The ordered regimen must include a scale for insulin correction doses that defines necessary changes to insulin doses to address glucose levels that deviate from the target range.

5. The physicians' orders must be renewed daily to address the forthcoming 24-hour period.

Nurses' self-sufficient decision-making

RNs are authorized to manage glucose levels by adjusting insulin doses based on their knowledge and the protocol guidelines. Informed by the results of capillary blood glucose measurements, RNs will decide whether to apply the correction scale in addition to the initial insulin dose ordered for a patient by a physician. The RNs also continue to have responsibility for monitoring patients' glucose levels and diet and for ensuring appropriate documentation.

Patient education

RNs have primary responsibility for educating patients about appropriate lifestyle behaviors. At the time of discharge, patients should understand the required treatment to follow at home, the need for self-care, the steps they should take to avoid complications, and the importance of compliance. Referrals to relevant community-based clinicians should be made as needed.

Team training

Training of diabetes care team members is key to ensuring that the protocol is adopted as a safe and effective tool for treating hospitalized patients with diabetes or hyperglycemia. Training for young physicians and nursing staff members includes imparting comprehensive knowledge about diabetes, its treatment options (including pharmaceutical therapies), patient education, and discharge procedures for patients with diabetes. Physicians and nurses also undergo joint training on the protocol-based treatment and its elements, including treatment simulations for the entire staff.

Ratifying the Protocol

The need to develop this protocol originated from the RNs working on medical wards.

The protocol was ratified as follows within the hospital:

1. At the department level, by directors and head nurses of medical wards

2. At the professional level, by the Diabetes Unit

3. At the wing level, by the director of nursing

4. At the administration level, by the chief executive officer and other administrative team members

Protocol Training Program

Successful implementation of the protocol will depend on a training program that is customized to a multidisciplinary team and on the full assimilation of the protocol in hospital wards.

The nursing and medical staff who treat patients with diabetes or hyperglycemia will be trained on the goals of the protocol and its administration based on a basal-bolus insulin regimen, the use of an insulin dose correction scale .