Redefining inpatient diabetes care: A policy-driven approach to safe and effective technology use.

BACKGROUND

Patients with diabetes are using advanced diabetes self-management technology, such as integrated insulin pumps with continuous glucose monitors (CGM) during hospitalization. Concerns surround their use in the inpatient setting ranging from safety risks to provider and nursing comfort in overseeing these devices.

LOCAL PROBLEM: At a 332-bed hospital in the Southeastern United States, the inpatient insulin pump policy did not support current evidence-based clinical recommendations.

METHODS

An updated policy was designed, allowing patients to continue using automated insulin pumps during hospitalization. Pre- and postpolicy nursing knowledge surveys, patient glucose metrics (including mean Glucose and Time in Range of 70-180 mg/dl), and patient narratives were evaluated to determine if the inpatient policy maintained optimal glucose control, improved patient satisfaction, and increased nursing comfort levels.

INTERVENTIONS: The updated policy was applied to all patients admitted using automated insulin pumps over 19 weeks. Nursing education was provided on the new policy release.

RESULTS

Mean glucose was 153.6 mg/dl for time segments on automated insulin pump, versus 201.4 mg/dl for stand-alone insulin pump without CGM and 262.3 mg/dl with subcutaneous insulin injections. Time in range was achieved at 72.1% (goal >70%) for time segment patients continued automated insulin pump, versus 44.3% insulin pump without CGM and 31.7% on subcutaneous insulin injections. Five of nine realms on the postnursing survey showed significant improvement ( p < .05).

CONCLUSIONS

Applying an evidence-based policy that allows patients to remain on their automated insulin pump during hospitalization maintains glycemic control and patient satisfaction, as well as improves nursing comfort levels.