Assuntos
Algoritmos , Protocolos Clínicos , Prática Clínica Baseada em Evidências/organização & administração , Hipoglicemia/terapia , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Árvores de Decisões , Documentação , Educação Continuada em Enfermagem , Prática Clínica Baseada em Evidências/educação , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/metabolismo , Auditoria de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Oregon , Comitê de Profissionais , Gestão da SegurançaRESUMO
OBJECTIVES: To develop an algorithm to standardize capillary blood glucose (CBG) testing in nursing home and rehabilitation patients. DESIGN: Descriptive study in which an interdisciplinary team from a nursing home, a rehabilitation center, and a diabetes mellitus care program developed and tested a protocol to standardize diabetes management parameters and CBG testing frequency. SETTING: Department of Veterans Affairs nursing home and rehabilitation unit. PARTICIPANTS: One hundred one patients admitted to the units during the 6-month study period who had orders for CBG testing. INTERVENTION: Use of a standardized CBG testing protocol. MEASUREMENTS: Use of management goal, use of CBG testing protocol, total CBG tests/month. RESULTS: One hundred one subjects received orders for CBG testing; 72 (72%) received orders for a management goal, and 69 (69%) received orders to use the CBG protocol. Of these 69 patients, 22 met their CBG goals and were advanced to less-frequent CBG testing using the protocol, and 15 did not meet their CBG goals and were not advanced. An additional 15 patients were advanced to less-frequent CBG testing but not using the protocol. In all, 54 of 69 patients (78%) were advanced or could have been advanced by protocol to less-frequent CBG testing. Total CBG testing per month did not change before, during, or after the study period. CONCLUSION: This protocol would be useful in long-term care facilities and in other congregate living settings where patients with diabetes mellitus have staff assisting with their diabetes management. Barriers to successful implementation are discussed.