Date of Paper/Work

5-2012

Type of Paper/Work

Systems Change Project

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Corjena Cheung

Abstract

The prevalence of diabetes is on the rise and this demand for services challenges health care organizations to provide quality, cost-effective care. The current system and processes at St. Joseph’s Area Health Services (SJAHS) needed redesigning to optimize quality diabetes care. This necessitated the need to move forward with a systems change project to transform diabetes care. The purpose of this study was to compare outcomes on glycemic control between current practice and a diabetes evidence-based practice toolkit by collecting retrospective data pre and post-toolkit implementation. The review of the literature from 2003-2011 endorsed the need to evaluate an innovation that incorporates a multidisciplinary, comprehensive, patient-focused approach to improve glycemic control. There is limited research on glycemic control for the hospitalized noncritical medical patient. The literature supported further research to generate additional scientific knowledge surrounding glycemic control in the hospital setting. The innovation was a toolkit composed of several tools to support the implementation of a comprehensive, multidisciplinary plan of care for the patient with diabetes. The toolkit provided the structure and processes to optimize diabetes care in the hospital setting. The study sample included 168 hospitalized adult patients with an age range of 20-95 and a mean age of 69.8, all with a diabetes diagnosis, and insulin therapy. The results indicated there was not a significant decrease in glycemic control from pre-toolkit to post-toolkit implementation timeframes. The findings suggested that the toolkit has not been adopted by all members of the health care team therefore glycemic control did not improve with toolkit implementation. Despite the results SJAHS has the elements to be successful with this innovation and based upon the knowledge we have gained we are on a journey to improve diabetes care. The findings will be utilized to determine next steps in regards to the toolkit as an innovation to improve diabetes care.

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