Mary Fran Tracy, PhD, RN, APRN, CNS, FCNS, FAAN, is Nurse Scientist, Fairview Health Services, and an Associate Professor, School of Nursing, University of Minnesota Medical Center, Minneapolis. Carol Manchester, MSN, RN, ACNS-BC, BC-ADM, CDE, is Diabetes Clinical Nurse Specialist, Fairview Health Services, University of Minnesota Medical Center, Minneapolis. Michelle A. Mathiason, MS, is Statistician, University of Minnesota School of Nursing, Minneapolis. Jeff Wood, BA, is Senior Data Analyst, Fairview Health Services, University of Minnesota Medical Center, Minneapolis. Amy Moore, MS, RN, AGCNS-BC, CDE, CDTC, is Diabetes Clinical Nurse Specialist, Fairview Health Services, University of Minnesota Medical Center, Minneapolis.
Nurs Res. 2021 Jan/Feb;70(1):15-23. doi: 10.1097/NNR.0000000000000478.
Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality.
This was a retrospective pre-post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention, timeliness of adherence to the hypoglycemia protocol, the number of treatment interventions, and time to return patients to euglycemia were analyzed.
Data from hospitalizations of patients who experienced hypoglycemia (<70 mg/dl) and met inclusion criteria 1 year prior to intervention and 3 years postintervention were extracted, including demographics, glycemic control medications, diagnostic-related group, length of stay, and Charlson comorbidity index. For clarity and to determine if any significant change was sustained, the analysis compared data from 1 year prior to intervention to the second-year postintervention.
A total of 7,895 unique hypoglycemic events in 3,819 patients experiencing 20,094 hypoglycemic measures were included in the analysis. Patients were primarily adult, female, and White. Only 58.7% of the sample had diabetes; the median Charlson comorbidity index was 6. Results demonstrated improvement postintervention to registered nurse hypoglycemia protocol adherence regardless of age category or hypoglycemia severity. There was a significant reduction in median time from the first hypoglycemia measure to the second measure. In addition, there was a significant difference in the number of treatment interventions and reduction in time from the first hypoglycemia measure to return of patient to a blood glucose of ≥70 mg/dl.
These study results support that the use of a standardized hypoglycemia protocol and appropriate nurse workflows enables nurses to manage hypoglycemia promptly and effectively in most acute and critically ill hospitalized patients. Results also supported a differentiation in nurse workflow for patients with mild versus severe hypoglycemia. Implementing these interventions may result in avoidance or mitigation of the potential consequences of severe and/or sustained hypoglycemia.
低血糖在住院患者中很常见，无论是否患有糖尿病。低血糖对住院患者存在显著风险，包括死亡率增加。
这是一项在学术医疗中心进行的回顾性前后研究，旨在干预措施中提高护士对低血糖方案的及时遵守率。分析了干预前后轻度和重度低血糖事件的数量、对低血糖方案的及时性遵守、治疗干预的数量以及患者恢复到正常血糖水平的时间。
提取了 1 年前和干预后 3 年内发生低血糖（<70mg/dl）且符合纳入标准的住院患者的数据，包括人口统计学、血糖控制药物、诊断相关组、住院时间和 Charlson 合并症指数。为了清晰并确定是否有持续的显著变化，分析比较了干预前 1 年与干预后第 2 年的数据。
共纳入了 7895 例低血糖事件和 3819 例患者，共 20094 例低血糖措施。患者主要为成年人、女性和白人。仅有 58.7%的患者患有糖尿病；中位 Charlson 合并症指数为 6。结果表明，无论年龄类别或低血糖严重程度，干预后护士对低血糖方案的遵守率均有所提高。从第一次低血糖测量到第二次测量的中位数时间显著缩短。此外，治疗干预的数量和从第一次低血糖测量到患者血糖恢复到≥70mg/dl 的时间也有显著差异。
这些研究结果表明，使用标准化低血糖方案和适当的护士工作流程可以使护士在大多数急性和重症住院患者中迅速有效地管理低血糖。结果还支持了针对轻度与重度低血糖患者的不同护士工作流程。实施这些干预措施可能会避免或减轻严重和/或持续低血糖的潜在后果。
