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BACKGROUND/RATIONALE:
The literature supports a strong relationship between tight glycemic control and patient outcomes in the hospitalized patient. Tight glycemic control in the medical/surgical setting is defined as the absence of any random glucose value over 180mg/dL. The benefits associated with tight control include decreased mortality, decreased length of stay, and decreased risk of infection. Portland VAMC has implemented non-ICU insulin infusion recommendations for glycemic management on medical/surgical units utilizing a paper platform. The existing gap is to implement the electronic insulin infusion program and conduct research which validate protocol adherence, barriers, safety and effectiveness.
OBJECTIVE(S):
The purpose of this study at PVAMC is to evaluate the implementation of an electronic Evidence-based Nursing non-ICU insulin infusion protocol.
METHODS:
This quasi-experimental study is an intervention/untreated control group design. The intervention RN group, from a 21-bed surgical unit, will receive a 45-minute educational session and implementation of an electronic insulin infusion protocol on their unit. The control group, RNs from a 36-bed surgical unit, will continue to use the existing standard of care. The evaluation will determine if the intervention is implemented as designed and produces the impact that has been conceptualized.
Method/Analysis Aim #1: Process adherence will be measured by evaluating the time interval between the time the CBG was obtained and the time an infusion adjustment was made. Only CBG values that indicate that an infusion adjustment is necessary will be included in the analysis. Corresponding infusion adjustment times will be obtained at the conclusion of each infusion by retrieving historical data from the infusion device event log. The intervention RN group will complete a multi-item self-perceived adherence survey. The analysis will utilize descriptive statistics to (1) compare the paper vs. electronic protocol adherence and (2) RN perceived protocol adherence and actual adherence. Barriers will be examined utilizing logistic regression analysis.
Method/Analysis Aim#2: The evaluation will include two measures utilizing electronic time stamps from glucometer data. The first measure will determine CBG frequency by measuring the time interval from one CBG value to the next CBG value. The CBG frequency allows for detection of deviation from the protocol. The second measure will determine the time interval from the obtained CBG value to transmission into the electronic patient record. The analysis will use descriptive statistics to report means, standard deviations and range values.
Method/Analysis Aim#3: An evaluation of each recorded insulin infusion adjustment will be conducted for correctness by entering the value into the electronic calculator associated the electronic insulin infusion protocol. The analysis will compute a rate of the number of incorrect infusion adjustment calculations divided by the total number of insulin infusion adjustment calculations.
Method/Analysis Aim #4: All participating RNs will complete a multi-item satisfaction survey. The analysis will use a control group design with a pretest and post-test. The intervention RN group will receive a pretest, post-test survey to measure change in knowledge pertaining to the protocol. We will analyze the data using paired t tests.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
None at this time.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Treatment, Quality of Care
Keywords:
Nursing, Practice patterns
MeSH Terms:
none
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