RESUMEN
The physical, emotional, and financial costs of caring for patients with chronic, nonhealing leg wounds are substantial. In fiscal year 2001, the home care department of a large Veterans Affairs medical center in the Pacific Northwest spent nearly half of its annual budget on veterans needing wound care. In this article, the authors describe a practice improvement project designed to improve the wound care management of homebound veterans with chronic, nonhealing lower extremity wounds using a research-based protocol and consultation by a certified wound care specialist, as well as the effect of this program on home care expenditures.
Asunto(s)
Protocolos Clínicos , Pierna/patología , Heridas y Lesiones/terapia , Benchmarking , Investigación Biomédica , Enfermedad Crónica , Servicios de Atención a Domicilio Provisto por Hospital , Hospitales de Veteranos , Humanos , Noroeste de Estados UnidosRESUMEN
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.