Redesigning Meal Delivery and Insulin Administration to Improve Overall
Blood Glucose (BG) Control
Sharp Healthcare looked to redesign a hospital meal delivery process to shorten the time between BG monitoring and corresponding insulin administration that matched the percent of the meal eaten. In an effort to evaluate the hospital's effect on glycemic control, nursing management received monthly hospital-wide and unit-specific glucometric reports that looked at various established metrics in which an opportunity existed for improvement (BG < 70 or > 180) and in the workflow process measures (time elapsed between pre-meal BG check and insulin administration).
Results were shared with nursing managers, as well as nutrition services to support the need for the meal delivery process change. They in turn met with leadership to present the proposed changes and the supporting hospital evidence: changes to BG and meal delivery times; glucometric reports and inconsistent unit meal delivery times.
As a result, this nursing lead process change redesigned the workflow of the dietary and nursing department. Modifications included nursing rather than dietary, delivering meal trays to patients receiving insulin. The nurse would also perform the BG when the meal tray arrived to ensure the most current BG results were used and confirm what percent of the meal the patient thought they would eat. If the patient stated 50 percent or more, they were given their full dose of insulin at that time. If the patient was unsure, the nurse would administer the insulin within 20–30 minutes from the start of the meal and assess the actual percent of meal consumed. Nurses were also educated with pictures of trays with differing amounts of food that would represent the percent of the meal eaten and insulin doses were adjusted if less than 50 percent of meal eaten based on established orders.
The results of this study showed significant improvements, and as a result the process change was approved for all nursing units.
For more information, please contact Jacqueline (Jacqui) Thompson, MAS, RN, CDE, Diabetes System Service Line Director, Sharp HealthCare, at Jacqueline.firstname.lastname@example.org.