NP017 Improving diabetes management in a regional hospital cardiovascular program

Abstract

Diabetes in Canada is reaching epidemic proportions. It is estimated that by 2012 approximately 2.8 million Canadians will be living with diabetes. Diabetics are hospitalized three times more often with ischemic heart disease, heart failure and stroke, compared with non-diabetics. A growing body of literature suggests that better glycemic control in the hospital setting may improve mortality and morbidity. The cardiovascular nurse has an integral role in recognizing and treating diabetes and its sequelae. Historically, despite the high prevalence of diabetes among in-patients, adequate glycemic control has not been a priority. For years, in-patient management of diabetes has involved the use of insulin. This reactive approach treats hyperglycemia after it occurs and has been largely unsuccessful, with higher rates of hyper and hypoglycemia. The purpose of this presentation is to inform health care professionals of an evidence-based transformation of in-patient diabetes management in our regional cardiovascular program. A multidisciplinary steering committee focused on five elements: 1) patient centre care; 2) nursing education; 3) policies; 4) hypoglycemia algorithms; and 5) two preprinted standardized insulin order sets, which focused on proactive basal, bolus and correction insulin. Compared with the previous sliding scale orders, the new standardized insulin therapies resulted in fewer episodes of hypoglycemia requiring intervention, and better glycemic control for the cardiovascular patient.