Role of Nursing in the Continuum of Inpatient Diabetes Care

Key Points

  • Nurses are essential—and central—to successful implementation of protocols, order sets, glucose monitoring, and educational programs to support improved glycemic control.

  • Because nurses oversee inpatient care on a 24-hour basis (regardless of the nursing system structure), nurses have opportunities to coordinate care of patients with hyperglycemia.

  • The individual nurses who will be most involved in implementing these systems should also be involved in planning, design, and evaluation of any new method for delivery of care.

  • Because each hospital is unique, all departments should be represented in designing an approach that will provide safe, quality care for inpatients with hyperglycemia.

  • Nursing in-service training, especially with regard to insulin therapy, should be both adequate and ongoing to ensure the needs of inpatients with hyperglycemia are met.

  • Diabetes educators and nursing staff should collaborate in the provision of basic “survival skills” when needed to allow for a safe discharge.

Suggested Reading

Clinical Guidelines

Deedwania P, Kosiborod M, Barrett E; American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2008;117:1610-1619.

Joint Commission. Advanced certification in inpatient diabetes.

Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15:353-369.

Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;154:260-267.

Society of Hospital Medicine. The case for supporting inpatient glycemic control programs now: the evidence and beyond. 2008.

Umpierrez GE, Hellman R, Korytkowski MT, et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2012;97:16-38.

Additional Reading

Anthony M. Hypoglycemia in hospitalized adults. Medsurg Nurs. 2008;17:31-34, 40.

Anthony M. Treatment of hypoglycemia in hospitalized adults: a descriptive study. Diabetes Educ. 2007;33:709-715.

Asudani D, Calles-Escandon J. Inpatient hyperglycemia: slide through the scale but cover the bases first. J Hosp Med. 2007;2(suppl 1):23-32.

Bates D, Clark NG, Cook RI, et al. American College of Endocrinology and American Association of Clinical Endocrinologists position statement on patient safety and medical system errors in diabetes and endocrinology. Endocr Pract. 2005;11:197-202.

Bates DW, Gawande AA. Improving patient safety with information technology. N Engl J Med. 2003;348:2526-2534.

Becker T, Moldoveanu A, Cukierman T, et al. Clinical outcomes associated with the use of subcutaneous insulin-by-glucose sliding scales to manage hyperglycemia in hospitalized patients with pneumonia. Diabetes Res Clin Pract. 2007;78:392-397.

Braithwaite SS, Buie MM, Thompson CL, et al. Hospital hypoglycemia: not only treatment but also prevention. Endocr Pract. 2004;10(suppl 2):89-99.

Chugh A, Williams MV, Grigsby J, Coleman EA. Better transitions: improving comprehension of discharge instructions. Front Health Serv Manage. 2009;25:11-32.

Davidson PC, Steed RD, Bode BW, et al. Use of a computerized intravenous insulin algorithm within a nurse-directed protocol for patients undergoing cardiovascular surgery. J Diabetes Sci Technol. 2008;2:369-375.

Giangola J, Olohan K, Longo J, Goldstein JM, Gross PA. Barriers to hyperglycemia control in hospitalized patients: a descriptive epidemiologic study. Endocr Pract. 2008;14:813-819.

Haas LB. Improving inpatient diabetes care: nursing issues. Endocr Pract. 2006;12(suppl 3):56-60.

Hadaway LC. Managing i.v. therapy: "high-alert" drugs keep nurse managers ever watchful. Nurs Manage. 2000;31:38-40.

Hellman R. A systems approach to reducing errors in insulin therapy in the inpatient setting. Endocr Pract. 2004;10(suppl 2):100-108.

Hellman R. Patient safety and inpatient glycemic control: translating concepts into action. Endocr Pract. 2006;12(suppl 3):49-55.

Kelly JL. Ensuring optimal insulin utilization in the hospital setting: role of the pharmacist. Am J Health Syst Pharm. 2010;67:S9-16.

Kripalani S, Jackson AT, Schnipper JL, et al. Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. J Hosp Med. 2007;2:314-323.

Leak A, Davis ED, Houchin LB, Mabrey M. Diabetes management and self-care education for hospitalized patients with cancer. Clin J Oncol Nurs. 2009;13:205-210.

Magee MF, Clement S. Subcutaneous insulin therapy in the hospital setting: issues, concerns, and implementation. Endocr Pract. 2004;10(suppl 2):81-88.

Manning EH, Jackson L. An evaluation of the timing between key insulin administration-related processes: the reasons why these processes happen when they do, and how to improve their timing. Aust Health Rev. 2005;29:61-67.

Metchick LN, Petit WA, Jr., Inzucchi SE. Inpatient management of diabetes mellitus. Am J Med. 2002;113:317-323.

Moghissi E. Hospital management of diabetes: beyond the sliding scale. Cleve Clin J Med. 2004;71:801-808.

Moghissi ES, Hirsch IB. Hospital management of diabetes. Endocrinol Metab Clin North Am. 2005;34:99-116.

Pollom RD. Optimizing inpatient glycemic control with basal-bolus insulin therapy. Hosp Pract (Minneap). 2010;38:98-107.

Pollom RK, Pollom RD. Utilization of a multidisciplinary team for inpatient diabetes care. Crit Care Nurs Q. 2004;27:185-188.

Schnipper JL, Ndumele CD, Liang CL, Pendergrass ML. Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: results of a clinical trial. J Hosp Med. 2009;4:16-27.

Seggelke SA. Hitting the target for inpatient glycemic management. Nurse Pract. 2011;36:24-31.

Spollett G. Promoting continuing education in diabetes management. Endocr Pract. 2006;12(suppl 3):68-71.

Vriesendorp TM, van Santen S, DeVries JH, et al. Predisposing factors for hypoglycemia in the intensive care unit. Crit Care Med. 2006;34:96-101.

Walker R. Managing diabetes in the hospital setting: a nurse-patient partnership. Prof Nurse. 2003;19:175-177.

Wesorick DH, Grunawalt J, Kuhn L, Rogers MA, Gianchandani R. Effects of an educational program and a standardized insulin order form on glycemic outcomes in non-critically ill hospitalized patients. J Hosp Med. 2010;5:438-445.

Wheeler K, Crawford R, McAdams D, et al. Inpatient to outpatient transfer of diabetes care: perceptions of barriers to postdischarge followup in urban African American patients. Ethn Dis. 2007;17:238-243.