An Evidence-Based Protocol for the Assessment and Management of Glucocorticoid-Induced Hyperglycemia.
An Evidence-Based Protocol for the Assessment and Management of Glucocorticoid-Induced Hyperglycemia.
Date
2018-05
Authors
Tanhchaleun, Amanda
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Nursing Practice
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Abstract
Glucocorticoid-induced hyperglycemia (GCIH) has been associated with negative patient
outcomes. Oncology inpatients are particularly affected by GCIH, as they are prescribed highdose
glucocorticoids (GC) during their hospitalization. Yet, organizational data highlights
variability in treatment, suboptimal glycemic control, and a gap in the timeliness of therapy.
The purpose of this Doctor of Nursing Practice (DNP) project was to improve GCIH assessment
and management for oncology inpatients receiving GCs. The Iowa model was used as the
guiding framework for translating evidence into clinical decision-making for this project.
An evidence-based protocol that included a Best Practice Advisory (BPA) within the
electronic medical record and a standardized algorithm was developed and implemented. The
goal was to immediately initiate blood glucose monitoring (BGM) and sliding scale insulin (SSI)
therapy in concurrence with a GC order to promptly detect and treat GCIH, thereby reducing
uncontrolled hyperglycemia rates. Average length of stay (ALOS) days were also evaluated to
assess for any correlations with Diabetes Team consults and uncontrolled hyperglycemia rates.
The sample group within a four-month period comprised of 49 patients with hematologic
malignancies who were prescribed GCs. The results revealed an improvement in BGM orders,
Diabetes Team consults that met criteria, total uncontrolled hyperglycemia episodes, and
hypoglycemic events. There was a decrease in SSI orders and an overall increase in ALOS by
six days. A trend in more prolonged hospitalizations was noted in patients with uncontrolled
hyperglycemia.
The data was not strong enough to produce conclusions for both process and impact
evaluations. It is possible that a Hawthorne effect occurred as a result of a recurrent discussion
of this project at multiple meetings. It is challenging to infer a direct correlation of ALOS with
Diabetes Team consults due to many potential influential factors.
Improvement in GCIH detection and management resulted in a reduction of uncontrolled
hyperglycemic episodes. Further benefits associated with GCIH management need to be
explored with larger samples.
Limitations included sample size and time, patient right to refusal of care, staffing
considerations, variance in clinical judgment and preferences for administrative autonomy, and
factors impacting ALOS and hyperglycemia.
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Keywords
Glucocorticoids,
hyperglycemia,
cancer,
oncology,
inpatient
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