Developing Clinical Nurse Leaders at the Bedside Utilizing Diabetes Management Tools

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Developing Clinical Nurse Leaders at the Bedside
Utilizing Diabetes Management Tools

• Sharon Schwarz, RN, MSN, CDE, APRN, BC-AD

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GOALS FOR DIABETES MANAGEMENT IN CHILDREN

• Normal growth development
• Optimal glycemic control
• Minimal acute or chronic complications
• Positive psychosocial adjustment

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GOALS FOR DIABETES MANAGEMENT IN CHILDREN

• TARGET BLOOD GLUCOSE RANGES
• 0verall target blood glucose range is 80-150.
• Acceptable range 70-180.

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INSULIN TYPES/DOSING IN CHILDREN

• Type of insulin used is based upon
• age
• eating patterns
• family patterns
• is individualized to meet all of above
• Diabetes Team should work together with family to
  decide upon type of insulin regimen.

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Tools for success

• Mandatory on-line orientation tools for nurses
  with post-test covering general Diabetes
  Management, insulin pump therapy, and
  carbohydrate counting
• On- line admission orders for newly diagnosed
  Diabetes, transfers from PICU, regimen changes,
  insulin pump admits

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More Tools for Success

• On line prescriptions for children with Diabetes
• On line school forms for all children being
  discharged from hospital or having a regimen
  change in clinic
• Insulin dosage calculations on line for nursing
  and resident use
• Day by day education check-list for nurses

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Example Educational Tools/Supplies

• Regimen specific day planner with dosage
  instructions, blood glucose monitoring
  instructions, and sliding scale instructions
• Various insulin pens, inject-ease, short syringe
  needles for needle phobias and flexibility

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In-services for Nursing Staff

• 10-15 minute in-services with specific new topics
  for nurses on the unit
• Web based training programs
• All day seminars specific to MUSC patient
  guidelines
• Long term goal to credential specific nurses as
  CDEs

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Example of Nursing competency test for orientation

• Which insulin works within 5-10 minutes and last
  2-3 hours?
• a. Regular Insulin
• b. Humalog Insulin
• Which injection site has quickest
  absorption rate?
• a. Hips/buttocks
• b. Arms
• c. Abdomen
• The first choice for treatment of
  hypoglycemia in a 4 year old child is...
• a. 4 oz. juice with 2 packs of sugar
• b. 15 lifesavers
• c. 2-3 glucose tablets

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A good general rule for increased activity /
exercise is to ... a. Eat candy bar before
playtime b. Check blood glucose before increased
activity and add 10 grams complex carb for every
hour of increased activity if blood glucose is lt
100. c. Drink 6 oz. gatorade every 30 minutes-
1 hour. If blood glucose is 50 in middle of the
night , treat with... a. Give 2-3 glucose tabs
only b. Give glass of juice and Peanut butter
sandwich c. Give 2 glucose tabs , recheck blood
glucose in 10-15 minutes - once above 70 give10
grams of complex carb with protein (milk or
crackers)
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You should wait until discharge day to fill
prescriptions for all newly diagnosed patients.
True/ false The best drink for anyone with
Diabetes is juice. True/ false Glucagons
biggest side effect is headache? True/ false
All children on insulin require a morning ,
after school, and bedtime snack? True /false It
is OK to eat snack after school at 330pm-400pm
if on Lantus. You do not need to cover with
Novolog/Humalog. True /false If a child has
large ketones and blood glucose of 400 and you
have orders to give 10u humalog for blood glucose
gt 300 and the child weighs 10kg, you should give
the insulin immediately to prevent DKA? True/
False
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If 1 line .10 units of Diluted Humalog 5 lines
--------- units. A. 0.5units b. 50 units c.
2 units d. 500 units If a child on insulin has a
stomach virus and isnt going to eat breakfast,
you should hold all insulin to prevent
hypoglycemia. True/False Kids with Diabetes
should be excused from PE class because they may
have hypoglycemia. True / False Follow up
appointments should be made by the patient for 3
months after
discharge. True/ False
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Feedback using tools

• Nurses and patients are much more satisfied with
  having tools that are standardized and ensure
  continuity of care
• Patients / families like having all of MUSC
  numbers and Diabetes instructions together in a
  book written by their caregivers and used by the
  nurses for teaching purposes