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Case Study

Relevant Evidence.

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Case Study

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  1. Relevant Evidence Amy, a 36-year-old Caucasian female, has been admitted to the hospital with a blood sugar of 300 and placed on an insulin drip. Amy is 50 pounds overweight smoker, a heavy drinker, and non-adherent to her medicationregimen of insulin. The hospital insulin drip protocol is to maintain serum blood sugar between 70 and 110mg/dl. A few months ago, a pilot research project indicated that a mean serum blood sugar for patients discharged from cardiac care units was 148. The nurses providing care to Amy ponder if the current protocol ranges are appropriate. Case Study Situation Focused Question The American Diabetes Association (ADA) and the American Association of of Clinical Endocrinologists (AACE) Inpatient Task Force now recommends against tight glycemic control less than 110 mg/dl for patients in the Intensive Care Unit (ICU) and suggests new glycemic targets (140-180 mg/dl) are more reasonable, achievable, and safer in patients receiving CII in the ICU setting. Evidence has indicated the use of maintaining blood glucose levels between 140-180mg/dl during insulin therapy of non-ICU patients. Studies also indicates that maintaining blood glucose levels between 140-180mg.dl is safe and effective on non-ICU patients. Results Actions CII protocol SBG levels between 110-150mg/dl Referrals for consults including endocrinologist, diabetic specialist, dietician, and outpatient support group. Ongoing diabetic education Monitor SBG on CII patients for six months Evaluate data, mortality rates, and hospital readmit rates in CII patients. References Adams, M. P., Holland, N., & Urban, C. (2014). Pharmacology for nurses: A pathophysiologic approach (4th ed.). Boston: Pearson. Bailey, V., Dziura, J., Goldberg, P., Halickman, J., Inzucchi, S., Lee, M., Lee, S., Sherman, R., & Siegel, M. (2004). Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care, 27(2), 461-467.doi: 10.2337/diacare 27.2461. Retrieved from: http://care.diabetesjournals.org/content/27/2/461.long Bilo, H.J.G., Hortensius, J., Jaap, J., Kars, M.C., Kleefstra, N., & Wierenga, W. S. (2012). Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study. BioMed Central Public Health, 12:167. doi: 10.1186/1471-2458-12-167. Retrieved from: http://www.biomedcentral.com/1471-2458/12/167 Jacobi, J., Bircher, N., Krinsley, J., Agus, M., Braithwaite, S., Deutschman, C., … Schunemann, H. (2012). Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Critical Care Medicine, 40(12), 3251-3276. DOI: 10.1097/CCM.0b013e3182653269. Retrieved from: http://www.learnicu.org/SiteCollectionDocuments/Glycemic_Control.pdf Smiley, D., Rhee, M., Limin, P., Roediger, L., Mulligan, P., Satterwhite, L.,…Umpierrez, G. (2010). Safety and efficacy of continuous insulin infusion in noncritical care settings. Journal of Hospital Medicine: An official publication of the society of hospital medicine. 5(4), 212-217. doi: 10.1002/jhm.646 Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/2039402 What is the highest level of evidence available in determining if the hospital’s current insulin drip protocol to maintain serum blood glucose (SBG) levels between 70 and 110mg/dl is effective for a 36 year old Caucasian female who is an overweight smoker, heavy drinker, and non-adherent to her home insulin regimen and has been admitted to the hospital with blood sugar of 300 and placed on an insulin drip? Auburn Montgomery Team Outlaw Susan Outlaw, Melissa Ashley, Mary Holston, Beverly McMillion Evidence Based Practice Report • The highest level of evidence from numerous research designs such as meta-analysis, quantitative, qualitative, and Random Controlled Trial (RCT) were utilized to determine and evaluate literature and identify the safety and efficacy of insulin infusion therapy for a defined glycemic range. • Population included adult medical/surgical and critical care patients receiving Continuous Insulin Infusion (CII). Exclusions were children, other hypoglycemic and anti-diabetic drugs. • Data collection methods included clinical questions to analyze data base searches, clinical variables and Acute Physiology and Chronic Health Evaluation II (APACHE II), clinical interventions from patient charts, nursing records, and in-depth interviews transcribed using Ground Theory Approach. • Data analysis methods utilized were tape recorded transcribed Maxqda 2007 in 3 phases of coding per review, blood glucose values of patients were compared using the Student’s t test and Wilcoxon rank-sum test, and retrospective analysis of 200 consecutive patients receiving CII.

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