Inpatient Glycemic Improvement Initiatives 10/2015-4/2017. Donna M. Gibbons RN MS CPT CDE Diabetes Program Manager 7/26/2017

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1 Inpatient Glycemic Improvement Initiatives 10/2015-4/2017 Donna M. Gibbons RN MS CPT CDE Diabetes Program Manager 7/26/2017 1

2 Communication Education Responsibility Teamwork Institutional Buy-In Frontline staff Implementation Equipment Data 2

3 Mission Glycemic Council To provide the highest quality healing, health and wellness, through coordinated care for our patients that live with Diabetes, their families and community. Vision Guided by Westchester Medical Center s VITAL Core values; We are: uccessful- We provide extraordinary clinical care and compassionate service every day. eamwork-we work together in a team that is multidisciplinary, supportive and collaborative. espect- We respond to patient needs, embrace diversity and treat each other with dignity and respect. ptimal care- We deliver the best evidenced based, individualized, patient centered care. ursing expertise We offer caring, competent Nursing and Nutrition excellence. lycemic management-we facilitate and oversee glucose management, to improve safety and provide innovative, quality care. Goals To improve diabetes related outcomes, reduce the risks of short and long term health complications, as well as promote improved quality of life in people living with diabetes. 3

4 Communication Culture & Coordination 4

System Communication World Diabetes Day awareness Diabetes Alert events Diabetes Lunch and

Healthy: Less fat and fewer calories* Make your plate look like this: Assess Your Risk for

Diabetes 6.5 or above 126 or above 200 or above Pre-Diabetes 5.7 to 6.

drink it Halt the salt. Stay hydrated. Be Active: Walk 30 minutes per day, 5 days per week.

5 System Communication World Diabetes Day awareness Diabetes Alert events Diabetes Lunch and Learn meetings DM information sessions You CAN Prevent Type 2 Diabetes (NDPP 2002) Eat Healthy: Less fat and fewer calories* Make your plate look like this: Assess Your Risk for Pre-Diabetes A1C Test Fasting Sugar Test ~ 2 hours after meal or Oral glucose test Diabetes 6.5 or above 126 or above 200 or above Pre-Diabetes 5.7 to to to 199 Normal About 5 99 or below 139 or below Eat your fruit, don't drink it Halt the salt. Stay hydrated. Be Active: Walk 30 minutes per day, 5 days per week. Stay at a Healthy Weight Overweight? Try to lose 7% of your totai body weight Control Stress: When in doubt, get checked out! 5

6 Education 6

Healthsource: Self-Learning Modules Group sessions

7 Responsibility & Teamwork Variety of education and training opportunities Continuing Education Healthsource: Self-Learning Modules Group sessions Huddle sheets Unit based education Individualized training Policy updates 7

8 Staff Education Preventing Hypoglycemia in the Hospitalized Patient Unit Hypoglycemia Documentation Reports Daily 8

9 Electronic documentation allows us to retrieve information to track and trend hypoglycemic events. This information is used to identify were we need to focus our efforts. Implementation

Advancing Hypoglycemia Safety - Inpatient Donna Gibbons, RN MS CPT CDE Nursing Professional Development Mary Ellen Higgins RN MS CPHQ Quality & Safety Karen Armada BSN Quality & Safety BACKGROUND

It also effective care for inpatient hypoglycemia, thus assisting nizational goals to improve inpatient glycemic ss, improved communication and coordination between ng for a patient has the

OBJECTIVES inpatient glycemic management efforts. a awareness endeavors for: udson Regional Hospital Ferrari Children's Hospital vioral Health Center REFERENCES n. (2017).

Alexander, C. M., Nathanson, B. H., Haidar, T., & Dubois, R. W. (2009). npatient diabetic hypoglycemia (15: 302-312). New York, NY: Endocrine urek, B., Manchester, C. S., & Noskowiak, D. (2017).

10 Advancing Hypoglycemia Safety - Inpatient Donna Gibbons, RN MS CPT CDE Nursing Professional Development Mary Ellen Higgins RN MS CPHQ Quality & Safety Karen Armada BSN Quality & Safety BACKGROUND METHODS RESULTS Images CONCLUSION and practice of timely point of care testing during s supports increased awareness of hypoglycemia ement and facilitation of prompt resolution. It also effective care for inpatient hypoglycemia, thus assisting nizational goals to improve inpatient glycemic ss, improved communication and coordination between ng for a patient has the opportunity to make a sing hypoglycemia risk and events. ent and monitoring that utilizes active surveillance, ble base for future glycemic related inpatient safety ment projects. OBJECTIVES inpatient glycemic management efforts. a awareness endeavors for: udson Regional Hospital Ferrari Children's Hospital vioral Health Center REFERENCES n. (2017). Standards of Medical Care in Diabetes- Classification of andria, VA: American Diabetes Association. uses of hypoglycemia- associated autonomic failure in diabetes (350: land Journal of Medicine. Alexander, C. M., Nathanson, B. H., Haidar, T., & Dubois, R. W. (2009). npatient diabetic hypoglycemia (15: ). New York, NY: Endocrine urek, B., Manchester, C. S., & Noskowiak, D. (2017). Role of Diabetes anagement (doi: / ). Chicago, IL: The American s. & Childs, B. (2013). Hypoglycemia and diabetes: a report of a workgroup of on and the Endocrine Society (36: ). VA: Diabetes Care. AACE Inpatient Glycemic Control Resource Center (2016). Avoiding ting [PowerPoint slide # 9]. Retrieved from AACE Inpatient Glycemic Control dicare and Medicaid Services SMDL #

11 Institutional & Frontline staff Buy-in Cafeteria: Diabetes Information table Encouraging Unit GM Leaders 11

Patient and Family Education Sweet Bytes: Healthy eating and

and Happy Hearts February 16 th 2017 Find the Fat March 2 nd

6 th 2017 Eating the Rainbow April 20 th 2017 Everyday

12 Patient and Family Education Sweet Bytes: Healthy eating and living discussions about Diabetes February 2 nd 2017 Healthy and Happy Hearts February 16 th 2017 Find the Fat March 2 nd 2017 Diabetes Alert March 16 th 2017 Luck of the GREENS April 6 th 2017 Eating the Rainbow April 20 th 2017 Everyday Wellness May 4 th 2017 Spring into Action May 18 th 2017 Back to the ROOTS 12

Responsibility Checking your Blood Sugar Checking Your Blood Sugar Teach Back

To tell if blood sugar is in target range or out o f control 2.

Clean hands, calibrate if needed, use new lancet & new test strip each test

What Is a good target range for your blood sugar?

Verbalizes importance of regular testing.

Has a meter and can state how to obtain testing supplies.

Cannot demonstrate proper procedure for checking blood sugar.

13 Responsibility Checking your Blood Sugar Checking Your Blood Sugar Teach Back Understanding Checks: Red Flags: 1. Why do you need to test blood sugar? To tell if blood sugar is in target range or out o f control 2..How do you test blood sugar? Clean hands, calibrate if needed, use new lancet & new test strip each test record numbers to bring to Health provider 3. What Is a good target range for your blood sugar? Demonstrates BG testing procedure with proper technique. Verbalizes importance of regular testing. Can identify BG values that are in and out o f appropriate range. Has a meter and can state how to obtain testing supplies. Does not check blood sugar Only check at times blood sugar w ill be good. Cannot demonstrate proper procedure for checking blood sugar. Reports blood glucose values not consistent with A1c. 4. When and how often should you test? Check w ith Health provider; Can test in the m orning, bedtim e, before taking insulin, before and after eating, before driving, when feeling side, when you fe e l sugar is low or high, w hen a change in usual routine 13

14 Education & Implementation Inpatient booklet High/Low Cards CHO cards Insulin instruction tool kit Television education EMMI Sweet Bytes discussion 14

15 Equipment EMMI 15

16 Data Daily hypoglycemia documentation report Daily report of inpatients with diabetes dignosis Monthly Unit Score Cards Monthly Dashboard: Critical Care and Non-Critical Care data A1C during course of stay for patients with DM A1C ordered for inpatients on insulin Partnership for Patients ADE Data SHM POC Data 16

17 17

18 Data Percent stay with a mean glucose 180 mg/dl Mean time between Glucose <70 and next documented 18

19 thank you! 19

Monthly WellPATH Spotlight November 2018: Diabetes

Monthly WellPATH Spotlight November 2018: Understanding : Prevention & Diagnosis, the most common disorder of the endocrine (hormone) system, occurs when blood sugar levels in the body consistently stay