Semester

Summer

Date of Graduation

2026

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Ann Hendrickson

Committee Member

Laurel Miner

Committee Member

Susanna McMillen

Committee Member

Cathy Schoen

Committee Member

Emily Smaniotto

Abstract

Introduction: Enteral nutrition (EN) is often necessary for hospitalized patients who are unable to meet their nutritional needs orally. Patients with diabetes mellitus (DM) receiving EN are at risk of hyperglycemia, which contributes to poor wound healing, infection, and prolonged hospitalization. Diabetes-specific formulas (DSFs) are designed to optimize glycemic control compared with standard formulas (SFs); however, their use is inconsistent due to the absence of standardized protocols.

Purpose: The purpose of this Doctor of Nursing Practice (DNP) quality improvement project was to implement and evaluate a protocol to increase DSF utilization among patients with DM receiving EN, with the goal of improving glycemic control.

Intervention: An evidence-based protocol guided providers in selecting DSF for patients with type 2 DM and indicators of poor glycemic control. Recommendations included initiating continuous EN with DSF within 48 hours of admission. Educational sessions and flyers were used to promote adherence.

Methods: The project was implemented on a surgical oncology unit at a large academic medical center in West Virginia, using the Plan-Do-Study-Act (PDSA) framework. Data were obtained from chart audits and analyzed with descriptive statistics, paired t tests, and chi-square tests. Measures included DSF prescribing frequency, blood glucose levels, and incidence of hypoglycemia.

Results: A total of 27 patients were evaluated. The DSF group (n = 14) had a mean daily blood glucose of 139.8 mg/dL (SD = 16.7), compared with 147.6 mg/dL (SD = 19.6) in the SF group (n = 13). Differences were not statistically significant, t(25) = 1.55, p = .152. A chi-square test revealed no significant association between DM history and formula selection, χ²(1, N = 27) = 0.00, p = 1.00.

Conclusion: Although results were not statistically significant, implementation of the DSF protocol demonstrated promising trends toward improved glycemic control. Findings support continued evaluation with larger samples to establish evidence for standardized DSF prescribing in patients with DM.

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