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Background: We investigated the timing problems associated with insulin administration, blood glucose (BG) monitoring and meal tray delivery on a sub-acute medical surgical unit in the only Academic Medical Center, Level 1 Trauma Center in the state of New Mexico. It was noted that BG monitoring did not coincide with meal delivery. Insulin administration was not coordinated with meal delivery and or BG monitoring and often would occur greater than 30 minutes after the delivery of the meal tray. There were no protocols in place for standards of practice regarding BG timing and insulin administration. We believed these process discrepancies were resulting in worse BG outcomes. Objective: The primary objective was to evaluate the timing of our current in-patient process between BG monitoring, insulin administration and bedside meal delivery. A second objective was to create workflows that would allow for this process to be completed within a 30 minute window. Third objective was to create protocols to guide staff with the most current evidence based practice. Method: This was a quality improvement workflow project on an adult inpatient unit where approximately one-third of patients receive insulin. We used time-in-motion studies and process mapping to quantitate and define our current process and to assist in creating effective interventions. We designed and instituted interventions including standardization of processes and meal delivery times. We developed a standardized nursing protocol for insulin delivery and BG monitoring. In the last stage we instituted nurse driven processes including glucose monitoring, meal delivery, and insulin administration. Process and outcomes measures were collected over one year. Results: We found a number of discrepancies with BG timing, meal tray delivery and insulin administration. Staff obtained BGs >30 minutes prior to meal 49% of the time, ranging from 166 minutes before meal to 98 minutes after meal. Meal timing was inconsistent; delivery to floor varied by 15-30 minutes each day, followed by tray audits taking \u226515 minutes on average. Outcomes measures for these same time periods showed a decrease in mean BG from 160.40 to 150.64. Other significant results shown in graphics to right


Presented at Society of Hospital Medicine, 05/13/2011, Dallas, TX.