Required Documentation
When you should perform a site assessment on an insulin pump and CGM device
What is every shift
What are the 4 performance measures associated with diabetes?
1.Insulin Pump Site Assessment- Whats needed?
2. Validate a critical low < 54mg/dl - How?
3.Pt having AM hypoglycemia and receiving PM glargine - What needs to happen?
4. Pt receiving correction only insulin with blood sugar consistently > 180mg/dl - What do we do?
Who should have the hypoglycemia order set ordered?
Order Hypoglycemia order set - if not already ordered by provider, for every patient on diabetes medications; orals, injectable or insulin.
As a nurse you can order this! This is a nurse driven protocol
If an adult patient has persistent HYPERglycemia (>180 mg/dL) what would you suggest to the provider?
. Suggest to provider – patient meets criteria to start basal insulin (glargine).
When does insulin self administration teaching start?
Insulin teaching is the resposibility of the staff nurse caring for the patient and should be intited as early as possibly/ at the bedside with each injections
Patients should be able to demonstrate how to self inject with a syringe and/or insulin pen prior to discharge
When Should Diabetes Care/ Education be started with the patient?
On the day of admission
What type of educations do you (RN) receive about diabetes?
1. Nursing Orientation
2. Required Diabetes e-learning
3. Diabetes Lecture offered throughout the year
4. Laminated pocket cards/ Badge buddies for RN's/PCTS
5. Unit huddles and staff meetings
6. Nursing M&M
What needs to occur for a blood sugar less than 54?
Critical low blood glucose re-check/ validation on a another finger in less than 5 minutes
If a patient is wearing a CGM (Continuous glucose monitor) can you use their blood glucose value on their CGM to administer insulin?
NO!! In order to administer a patient insulin, we must have a POCT using the hospital glucometer.
If an adult patient consistently has a blood sugar >140 mg/dL (the definition of HYPERglycemia) what do you do?
Consider having the meal changed to a consistent carbohydrate diet, obtain an A1C.
What assessment should be completed on admission when you have a diabetic patient?
Diabetes Knowledge assessment should be completed on admission for all diabetic patients
Purpose: This helps to individualize patient education and care
The Diabetes Knowledge assessment is located in:
- Admission profile tab under "Initial Diabetes Knowledge assessment" and Flow -sheets "Diabetes Knowledge assessment"
Who do we order an A1C for ?
1. For all diabetic patients (unless one is documents from last 3 months)
2. Non-diabetic patients with ACS, AMI, TIA and all stroke patients
You can order an A1C if none is ordered/ on record from the past 3 months!!
What would be an appropriate treatment of a blood sugar of 50 and the patient is NPO?
Full amp of D50 push over 3 minutes
250 mL bag of D10 infuses over 15 minutes
When should basal insulin (Glargine) be held?
Never!!!!
Long acting insulin/ basal insulin- manages blood sugars between meals and throughout the night. DO NOT HOLD BASAL INSULIN IF PATIENT IS NPO!
There is no administration criteria to hold basal insulin
When should Bolus (meal time) dose of rapid acting insulin be held?
When the patient is NPO or not eating
(You can still give the correction insulin of if patient is NPO and presents with hyperglycemia)
What documentation is required with every meal?
% eaten documentation is required with every meal!
What are the blood glucose target ranges for the unit you are working on?
1. Critical care 140-180 mg/dL
2. Non-Critical care: 100-180
Target may be individualized by provider, based on assessment and clinical judgment
When is it required that the provider be contacted for hypoglycemia?
Notify provider of blood glucoses less than 70 after 2 subsequent treatments
What is the target time frame for coordinating point of care testing, insulin and meal delivery?
POCT + insulin administration + meal consumed
Goal: START TO FINISH in 30 minutes
Is it ever appropriate to use the meal to treat hypoglycemia?
No- NEVER!!
When a patient experiences a low blood sugar (hypoglycemia) what documentation needs to be completed?
Hypoglycemia flow sheet
JC wants to see that nurses are documenting what they believe to be the CAUSE of that hypoglycemic event in the notes i.e. NPO, previous low in hospital, poor kidney function, interruption of tube feeding, tapering of steroids, decreased oral intake.
What is the glucose summary and where can it be found?
Glucose Summary Tool is a tool used to monitor pt's blood sugars, Ketones, % eaten, medications such as oral DM meds, insulin, steroids, rescue medications and to see if hypoglycemic flow-sheet was completed
-To find: go to Summary tab and search “glucose” *Wrench in prior to JC visit*
-Here you will be able to see all glucose trends including A1C, ketones, meds, steroids, POCT results, random glucose
What is the 3rd section of the hypoglycemic used for?
Prevention
What is stacking of insulin?
Rapid-acting insulin should NOT be administered more frequently every 3 hours to correct hyperglycemia.
What is the time frame permitted for discovery to recovery from hypoglycemia?
30 minutes