Blood glucose monitoring during hospitalisation: Advanced practice nurse and semi-automated insulin prescription tools

Abstract

Introduction: Hyperglycemia is very common in hospitalized patients and is associated with worse clinical outcomes.

Aims: We implemented a clinical and educational program to improve the overall glycemic control during hospital admission, and, in patients with HbA_1c > 8%, to improve their metabolic control after hospital admission.

Methods: Non-critical patients admitted to cardiovascular areas between October-2017 and February-2019. The program was led by an advanced nurse practitioner (ANP) and included a semiautomated insulin prescription tool. Program in 3 phases: 1) observation of routine practice, 2) implementation, and 3) follow-up after discharge.

Results: During the implementation phase the availability of HbA1c increased from 42 to 81%, and the ANP directly intervened in 73/685 patients (11%), facilitating treatment progression at discharge in 48% (de novo insulin in 36%). One-year after discharge, HbA1c in patients who were admitted during the observation phase with HbA1c > 8% (n = 101) was higher than similar patients admitted during implementation phase (8,6 ± 1,5 vs. 7,3 ± 1,2%, respectively, p < 0,001). We evaluated 47710 point of care capillary blood glucose (POC-glucose) in two 9 months periods (one before, one during the program) in cardiology and cardiovascular surgery wards. POC-glucose ≥250 mg/dl (pre vs. during: cardiology 10,7 vs. 8,4%, and surgery 7,4 vs. 4,5%, both p < 0,05) and <70 mg/dl (2,3 vs. 0,8% y 1,5 vs 1%, p < 0,05), respectively, improved during the program.

Conclusions: The program allowed improving inpatient glycemic control, detect patients with poor glycemic control, and optimize metabolic control 1-year after discharge.

Keywords: Advanced nurse practitioner; Diabetes mellitus; Educación terapéutica; Enfermera de práctica avanzada; Hiperglucemia; Hospital; Hyperglycemia; Mellitus diabetes; Therapeutic education.