title: A Journey to Improved Inpatient Glycemic Control by Redesigning Meal Delivery and Insulin Administration.
abstract: OBJECTIVE
  The purpose of this quality improvement project was to redesign a hospital meal delivery process in order to shorten the time between blood glucose monitoring and corresponding insulin administration and improve glycemic control.
  
  
  METHODS
  This process change redesigned the workflow of the dietary and nursing departments. Modifications included nursing, rather than dietary, delivering meal trays to patients receiving insulin. Dietary marked the appropriate meal trays and phoned each unit prior to arrival on the unit. The process change was trialed on 2 acute care units prior to implementation hospital wide. Elapsed time between blood glucose monitoring and insulin administration was analyzed before and after process change as well as evaluation of glucometrics: percentage of patients with blood glucose between 70 and 180 mg/dL (percent perfect), blood glucose greater than 300 mg/dL (extreme hyperglycemia), and blood glucose less than 70 mg/dL (hypoglycemia).
  
  
  RESULTS
  Percent perfect glucose results improved from 45% to 53%, extreme hyperglycemia (blood glucose >300 mg/dL) fell from 11.7% to 5%. Hypoglycemia demonstrated a downward trend line, demonstrating that with improving glycemic control hypoglycemia rates did not increase. Percentage of patients receiving meal insulin within 30 minutes of blood glucose check increased from 35% to 73%.
  
  
  CONCLUSIONS
  In the hospital, numerous obstacles were present that interfered with on-time meal insulin delivery. Establishing a meal delivery process with the nurse performing the premeal blood glucose check, delivering the meal, and administering the insulin improves overall blood glucose control.
  
  
  CONCLUSIONS
  Nurse-led process improvement of blood glucose monitoring, meal tray delivery, and insulin administration does lead to improved glycemic control for the inpatient population.
authors: Author Affiliations: Diabetes Nurse Specialist (Ms Engle), and Nurse Manager, Acute Care Services (Ms Ferguson), Sharp Grossmont Hospital, La Mesa; and Professor, School of Nursing, San Diego State University, and Program Manager, Sharp Grossmont Hospital, San Diego State University, La Mesa, California (Dr Fields).
authors: Martha
authors: M
authors: Engle
authors: Allison
authors: A
authors: Ferguson
authors: Willa
authors: W
authors: Fields
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D004334:Drug Administration Schedule; D005521:Food Service, Hospital / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage*; D062407:Meals; D009732:Nursing Care / Q000458:organization & administration; D015403:Nursing Evaluation Research; D058996:Quality Improvement; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin