Diabetes care policies and practices in Michigan nursing homes, 1991.
OBJECTIVE
To describe local standards of care for nursing home patients with diabetes, to characterize the care that nursing home patients with diabetes receive in Michigan, and to determine if the care provided meets local and national standards.


METHODS
In March 1991, a questionnaire was administered and chart reviews were conducted as part of the Medical Review and Nursing Evaluation conducted by the Michigan Department of Public Health. The questionnaire was completed by the head nurses at 17 skilled nursing homes to learn about local institutional standards of care. Chart reviews were conducted on a sample of five patients with diabetes from each nursing home to describe the care provided and to compare it with local and national standards.


RESULTS
Almost all nursing homes had some diabetes care orders or protocols. Standing orders were most often present to guide nutritional and nursing care (e.g., diet, blood glucose monitoring, foot care). Standing orders were less often present to guide medical care (e.g., blood glucose parameters to contact physician) and surveillance of complications (e.g., eye exams). In general, the care provided did not meet local or national standards for diabetes care. Care practices were closer to national standards when registered dietitians (RDs) participated in meal planning and written institutional policies existed.


CONCLUSIONS
In this sample of Michigan nursing homes, those with RDs and standing orders provided care more in keeping with guidelines. There is room for improvement in diabetes care practices in nursing homes. It may be time for diabetes-related organizations to re-examine standards for diabetes care in nursing homes.
Funnell
M M
MM
MDRTC, University Hospitals, Ann Arbor 48109-0832, USA.
Herman
W H
WH
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D003927:Diet, Diabetic; D004046:Dietetics / Q000592:standards; D005260:Female; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008824:Michigan; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards; D009735:Nursing Homes / Q000592:standards*; D017410:Practice Guidelines as Topic; D012917:Social Adjustment
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin