Glucose management by registered nurses for adult patients hospitalized in medical wards: Structured guidelines (protocol) and working process

Abstract

Hyperglycemia in hospitalized patients is a common severe condition leading to poor clinical results, extended lengths of stay, disability, and elevated morbidity. According to ADA and ACE recommendations, guidelines and protocols for efficient treatment of hyperglycemia should be developed. Recently, the Israeli National Diabetes Council acted on the need for standardization of care by calling for inpatient management of glucose levels according to uniform professional guidelines. The council also emphasized the need to extend the authority of RNs to make management decisions about insulin doses, with the aim of improving glucose control in hospitalized patients. Nurses are the professional authority who care for patients on hospital wards 24 hours a day and are the personnel who are closest and most accessible to patients. Therefore, the protocol described in this article expands the authority of nurses in controlling blood glucose levels in patients with diabetes.The aim of this project was to develop a protocol for inpatients in medical wards, based on recommendations available in the literature and outlined by the National Diabetes Council of Israel. The protocol, based on the joint work of physicians and nurses, confers on RNs the authority to manage patients' glucose levels and defines the division of authority between nurses and physicians. The implementation of the protocol includes a training program that is customized to a multidisciplinary team and assimilation of the protocol in all medical wards. Protocol effectiveness will be assessed in a study examining blood glucose control in hospitalized patients before and after its implementation.