LEADING THE WAY : SHARING KNOWLEDGE THROUGH PRESENTATIONS
As a research and thought-leader , Baylor Jack and Jane Hamilton Heart and Vascular Hospital nurses and other clinical staff members regularly share outcomes data and best practice information with colleagues at regional , national and international conferences and events . In fiscal year 2016 , there were many opportunities to prepare presentations and posters on best practices . Highlights for fiscal year 2016 are :
Hypoglycemia can kill ! New protocols are long overdue ! Team Leaders : Louise Meymand , DC , BSN , RN-BC and Jennifer J . Jones , MSN , RN , AGCNS-BC , CCRN-K
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Background
The long established protocol for the monitoring of diabetic patients in the hospital setting has become unviable due to advancements in diabetic medications . New diabetic medications have longer acting effects , increasing the incidence of hypoglycemic events in the diabetic inpatient population . This translates into increase in length of stay , hospital costs , and risk of in-hospital mortality .
Search Method
A multidisciplinary taskforce was formed to address the clinical question . Initially , data was reviewed and expert advice sought from team members at a sister facility that successfully reduced hypoglycemic events . Areas of focus were identified specific to our noncritical surgical patient population . A literature search yielded evidence for practice changes .
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Clinical Question
What can be done to reduce hypoglycemic events in our non-critical surgical patients ?
Revised Handoff Tool
Developed to help nurses identify which patients are at high risk for developing hypoglycemia .
Steps Taken
PLAN : Form a multidisciplinary hypoglycemia taskforce consisting of PCT ’ s , nursing , education , endocrinology , pharmacy , and nutrition , to focus on creating and implementing a process improvement plan identifying patients at high risk for developing hypoglycemia .
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HCAHPS Baylor During Scott Implementation
& White Hypoglycemic Events
Council Implementation
Process of Implementation
� Mandatory Educational in-services for all RNs and Patient Care Techs .
� Thorough history taking upon admission to identify high risk diabetic patients .
� Close monitoring of blood glucose levels before and after Insulin administration and CHO intake .
� Updated Debriefing and Handoff Tools provided for each nursing unit .
� Reference sheets for long acting insulins and sulfonylureas placed on each medication distribution unit .
Baylor Heart and Vascular Hypoglycemic Events
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Implications for Advancing Practice
Development of a tool to identify non-critical surgical patients at high risk for developing hypoglycemia served as a key component in reducing hypoglycemic events in our target population .
Utilization of these tools resulted in improved communication between the admitting , surgical team , recovery room , and discharge nurses , thereby decreasing hypoglycemic events .
Posting up to date diabetic medication reference sheets on all floors improved staff awareness and understanding of diabetic patients ’ physiological patterns .
Daily concurrent review of hypoglycemic events and circumstances allowed for immediate identification of process improvement opportunities with the multidisciplinary team in order to ensure continued advancement in the hypoglycemic management process .
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Results
Since implementation of the Hypoglycemic Process Improvement , hypoglycemic events in non-critical diabetic surgical patients decreased from an average of 8 events to almost 0 events per month . Nursing staff have become more astute of diabetic medications
Outcomes
The target goal developed by Baylor Scott & White Health for 2015 was a 0.74 % incidence in the subject population . Baylor Heart and Vascular Hospital ended 2015 with a 0.05 % incidence .
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DO : Education provided related to glycemic management and process improvement in July of 2015 . |
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CHECK : Daily monitoring of hypoglycemic events . |
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ACT : Each hypoglycemic event is reviewed and education provided as needed . |
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www . baylorhearthospital . com |
Comprehensive Unit Based Safety Program : Briefings , Scorecards , and Transparency . Robert Williams , MBA , BSN , RN , NEA-BC , Magnet ® Conference , Atlanta , Ga . October 2015 .
Hypolycemia Can Kill ! New Protocols are Long Overdue ! Jennifer Jones , MSN , APRN , AGCNS- BC , CCRN-K and Louise Meymand-Pelletier , BSN , RN-BC , American Society of PeriAnesthesia Nurses , Philadelphia , Pa . April 2016 .
Getting to Zero Readmissions . Lindsey Briley , BSN , RN-BC and Stuart Mach , BSN , RN-BC , Baylor Scott & White Health Nursing Quality Summit , Dallas , Texas . June 2016 .
Hypolycemia Can Kill ! New Protocols are Long Overdue ! Jennifer Jones , MSN , APRN , AGCNS- BC , CCRN-K and Louise Meymand-Pelletier , BSN , RN-BC , Baylor Scott & White Health Nursing Quality Summit , Dallas , Texas . June 2016 .
From Frustrated to Elated : A Patient Satisfaction Intervention that Works ! Robert Williams , MBA , BSN , RN , NEA-BC , Baylor Scott & White Health Nursing Quality Summit , Dallas , Texas . June 2016 .
From Frustrated to Elated : A Patient Satisfaction Intervention that Works ! Robert Williams , MBA , BSN , RN , NEA-BC , Beryl Institute , Dallas , Texas . April 2016 .
Building a World Class Patient Experience . Robert Williams , MBA , BSN , RN , NEA-BC , Press Ganey , Orlando , Fla . November 2015 .
Return to Work Lab . Stephanie McCray , RN and Jenny Adams , PhD , American Nurses Association , Orlando , Fla . March 2016 .
Training Our Future Leaders : Empowering Nurses to be World-Class , Quality Forerunners . Megan Ramos , MSN , RN-BC and Lindsey Briley , BSN , RN-BC , American Nurses Association , Orlando , Fla . March 2016 .
Confusion to Creation of a Computer Charting Council . Amanda Their , MSN , RN-BC and Robert Williams , MBA , BSN , RN , NEA-BC , American Nurses Association , Orlando , Fla . March 2016 .
Mind the Gap : A Multidisciplinary Approach to Improve Communication Between Staff and Family After Procedures . Aneesa Hojat , BSN , RN , CCRN and Robert Williams , MBA , BSN , RN , NEA-BC , American Nurses Association , Orlando , Fla . March 2016 .
Cardiac Rehab Methodology , Inpatient Cardiac Rehab , and the Cardiac Rehab Experience : Day 1 to Graduation . Tim Bilbrey , MBA , 7th National Advanced Training Course of Cardiac Rehabilitation , Changsha , China . May 2016 .*
Cardiac Rehab Evidence-based Practice / Research , Exercise Training and Prescription for Open Heart Surgery Patients ( CABG , Valve Repair / Replacement , Heart Transplant ), Return to Work Lab . Jenny Adams , PhD , 7th National Advanced Training Course of Cardiac Rehabilitation , Changsha , China . May 2016 .*
Dietary Guidelines for Americans and Cardiac Rehab Nutrition Guidelines , Cardiac Rehab Nutritional Counseling . Erin Griffith , RD , 7th National Advanced Training Course of Cardiac Rehabilitation , Changsha , China . May 2016 .*
Comparison of Activity Forces Between Patients Who Follow Traditional Sternal Precautions Versus Those Who Follow a Unique Post-Sternotomy Discharge Education Model “ Keep Your Move in the Tube .” Pasquale Carbone , MS , American Association of Cardiovascular and Pulmonary Rehabilitation National Conference , New Orleans , La . September 2016 .
Continuous Blood Pressure Monitoring During High Intensity Resistance Training in a Cardiac Rehabilitation Setting . Katelyn Brown , BS , American Association of Cardiovascular and Pulmonary Rehabilitation National Conference , New Orleans , La . September 2016 .
* Presentation via Web-based meeting technology
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