Semester

Fall

Date of Graduation

2024

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Kendra Barker

Committee Co-Chair

Julia Linton

Committee Member

Susanna McMillen

Committee Member

Emily Smaniotto

Committee Member

Jennifer Olczak

Abstract

Abstract

Development of an Order set to Improve Consistency of Blood Glucose Monitoring for Adult Hospitalized Patients on Enteral Feeding

Kristen Calebaugh, BSN, RN

Background

Hospitalized patients often require artificial nutrition through either enteral feeding, placing the patient at risk for glucose alterations related to physiological responses of nutritional metabolism. Historically, there has been no standard of care or consistency aligning tube feedings times with point of care blood glucose testing. Without a standardized order set to guide blood glucose monitoring orders, patients on artificial nutrition may experience undetected hypo or hyperglycemia or inadequate glycemic control, which can cause adverse outcomes such as increased morbidity and mortality. Lack of a standardized protocol for monitoring can also lead to confusion among the nursing staff.

Purpose

This quality improvement project aimed to develop a standardized tube feeding and blood glucose monitoring order set for hospitalized adult patients receiving enteral nutrition in the form of bolus tube feeds. The creation of an order panel aimed to create a standardized schedule for patient care, improved blood glucose monitoring, and consistency for the nursing staff.

Interventions

Creation of an order panel designed to create consistency in tube feed bolus administration times and blood glucose monitoring. Integration of the order panel into the electronic health record system used at the hospital, EPIC. The intervention was launched as a pilot on one unit at the university hospital to assess the efficacy of the order set.

Methods

The order panel was developed based on scientific evidence, clinical practice guidelines, and feedback from the healthcare providers at the organization. Once the pilot project was complete, data was collected to identify patients on enteral feeding on the pilot unit and whether or not the order panel was used successfully. Retrospective chart reviews were performed on all patients identified as being on the pilot unit and having adult bolus tube feeds ordered. Additionally, a post-intervention survey was sent out to pilot unit staff to assess success.

Results

Thirty-one patients were identified who were on the pilot unit and receiving bolus tube feeds and included in the project analysis. Analysis showed that approximately 29% of eligible patients had the order panel used. Out of these, approximately 70% of these orders were placed correctly. Additionally, a Likert-Scale post intervention survey to assess staff perception of the order panel. The results from the staff survey indicated that the intervention was easily incorporated into the workday, education provided was adequate, and the change offered improved timing of blood glucose monitoring and improved glucose control.

Conclusions

After conducting a pilot test of the utilization of a bolus tube feed and point of care blood glucose testing order panel, the project was found to develop consistency in order timing, provide patients with a standard of care, improve blood glucose control, and decrease variability and confusion among nursing staff. In the future, enhancements to the electronic health record and pilot order panel could result in a better understanding of the impact of the project.

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