Implementation of the AACE/ADA Recommendations for Glycemic Control at Maui Memorial Medical Center

Abstract

Background: In the past decade there has been an increased awareness of the clinical and economic burden of hyperglycemia in hospitalized patients. The in-patient setting provides an opportunity to optimize glycemic control by setting blood glucose targets and instituting therapies to slow disease progression and improve outcomes. The purpose of this evidence-based project was to improve glycemic control of hospitalized patients with diabetes at Maui Memorial Medical Center (MMMC). Methods: Kurt Lewin’s Change Theory model was used to implement the American Association of Clinical Endocrinologist’s and the American Diabetes Association’s (AACE/ADA) recommendations to improve management of dysglycemia in the diabetic in-patient population. The project took place at the MMMC, which employs 400 staff nurses and has 200 attending physicians. Seven medical and surgical units in the hospital used AACE/ADA recommendations for glycemic control. Thirty patients with a diagnosis of type 1 or type 2 Diabetes Mellitus (DM), for whom insulin was ordered, were reviewed for baseline data. Forty nurses were given a ten-question multiple choice diabetes quiz to establish their baseline knowledge of current practices for care of hospitalized patients with DM. A repeat assessment was conducted eight months after the AACE/ADA recommendations were in place. Results: Blood glucose within the AACE/ADA targets increased by 13% eight months after the recommendations was implemented. Hyperglycemia decreased by 5%, and Hypoglycemia decreased 8.4% from baseline. Nurses’ knowledge on in-patient diabetes care increased by 12% on a ten question multiple-choice quiz. Conclusion: Implementing this project has heightened staff awareness of standards for inpatient diabetes care. Improvements in glycemic control and nurse’s knowledge was seen with the implementation of the AACE/ADA recommendations. Improvements in hypoglycemia exceeded project goals. Improvements of blood glucose within target were less than expected, but the findings were encouraging enough to continue utilizing the AACE/ADA recommendation. The findings implicate this approach is useful in reducing hyper and hypoglycemia. Practice changes recommended by the AACE/ADA appear to be frozen in place and have become part of the normal workflow on all seven nursing units.