Development of a protocol for capillary blood glucose testing in nursing home and rehabilitation settings.
OBJECTIVE
To develop an algorithm to standardize capillary blood glucose (CBG) testing in nursing home and rehabilitation patients.


METHODS
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.


METHODS
Department of Veterans Affairs nursing home and rehabilitation unit.


METHODS
One hundred one patients admitted to the units during the 6-month study period who had orders for CBG testing.


METHODS
Use of a standardized CBG testing protocol.


METHODS
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.


CONCLUSIONS
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.
Mader
Scott L
SL
Portland Department of Veterans Affairs Medical Center, Portland, Oregon, USA. scott.mader@med.va.gov
Fuglee
Kathleen A
KA
Allen
Deanna S
DS
Werner
Lisa R
LR
Wanlass
Wendy A
WA
Pagel
Keith J
KJ
Beliel
Kay L
KL
McEuen
Judy A
JA
Stephens
Elizabeth A
EA
Allison
Nancy L
NL
McWhorter
Karen A
KA
Vandling
Julie E
JE
D000368:Aged; D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D002196:Capillaries; D002985:Clinical Protocols; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards*; D009735:Nursing Homes / Q000458:organization & administration; D009922:Oregon; D012047:Rehabilitation Centers / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs
D001786:Blood Glucose