Nancy Moline - Improving Diabetes Management: Tools for the Nurse

Until recently, glucose control in the hospital setting was largely ignored even in patients with a diagnosis of diabetes. We didn’t realize 1 out of every...

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Information

Faculty:: Nancy Moline
Duration:: Full Day
Format:: Audio and Video
Copyright:: May 19, 2017

Description

Strategies to Reduce the Incidence of Hypo & Hyperglycemia in the Acute Patient
Critical Interventions for the Patient in Crisis
Treating Special Populations: Easy to Use Formulas
The Importance of Dosing & Timing
Tips & Tools You Can Put into Practice the Next Day

Until recently, glucose control in the hospital setting was largely ignored even in patients with a diagnosis of diabetes. We didn’t realize 1 out of every 3 patients we were caring for was potentially suffering the consequences of uncontrolled hyperglycemia and, worse, these unknown patients were experiencing higher mortality rates after discharge. Bottom line, we MUST do better and you, the bedside nurse, play a critical role in identifying and managing your hypo and hyperglycemic patients.

This seminar will address issues you face in the hospital and give answers to questions you won’t find in any textbook. Imagine being able to look at a single flowsheet and understand exactly why your patient continues to experience hypoglycemia, or persistent hyperglycemia. Expert, Nancy Moline, RN, M.Ed., CDE, will share with you the management techniques and tips she has developed through her extensive experience and increase your understanding of the complexities of diabetes. You will leave this seminar with new tools and formulas to improve the outcomes of your patients with and without diabetes diagnosis.

Handouts

	Manual ZNM077340 (6.01 MB)	63 Pages	Available after Purchase

Outline

Glycemic Targets for Hospitalized Patients

Clear interpretation of AACE & ADA guidelines
Adjusting limits for the critically ill patient
Non-critical patients: How high is too high

Recognizing Symptoms of Hypoglycemia

Hypoglycemic unawareness: How are we missing this?
Interventions that change outcomes
15/15 Rule
Timing and Dose: The good, the bad, the ugly
- IV dextrose
- Glucagon

Reducing Incidence of Hypoglycemia

Finger sticks & technique – it does matter!
Critical timing for pre-meal & correction insulin
The nurse’s role in ensuring carbohydrate-consistent meals

Symptoms & Critical Interventions for Hyperglycemia

The differences of DKA & HHNK
Diabetic Ketoacidosis
- A complex metabolic process
- Identifying the patient at risk
- Managing fluid replacement to avoid complications
- Insulin drips
- Critical labs & acute management
Nursing Management of HHNK
- Identifying the symptoms
- Don’t forget your ABCs
- Common laboratory pitfalls
- Restoring electrolyte balance

Consequences of Acute Hyperglycemia

Addressing & managing new wound infections
The dangers of:
- Platelet abnormalities
- Inflammatory cytokine response
The patient & the facility at risk:
- Poor patient outcomes
- Readmissions
- Increased length of stay
Insulin resistance

Treating Special Populations Using a Simple Formula

The patient newly prescribed steroids
Adjusting for tube feedings
TPN: Understanding the effects for the diabetic patient
Considerations for patients on R-U-500 insulin

Insulin for Improved Glucose Control

Type 1 vs. Type 2 guidelines
Action times of insulins
Calculating Basal/ Bolus Insulin
Miami 4/12 Rule
Correction scales based on insulin sensitivity

Oral Agents in the Hospital Setting

NPO vs eating status
Precautions for Metformin

Safety Issues with Managing Insulin Pumps

Patient exclusion criteria
Recognizing pump problems
When to remove pumps

System Improvements Positively Impacting Patient Outcomes

Standardized correction scales based on insulin sensitivity
Standard protocols for treating hypoglycemia
Physician order sets for insulin initiation
Carbohydrate labels on meal trays/snacks

Putting It All Together

Case Studies: What went right and what went wrong
Solving problems using the glucose accordion flowsheet report

Faculty

Nancy Moline, RN, M.Ed., CDE Related seminars and products: 2

Nancy Moline, RN, M.Ed., CDE, has more than 25 years of experience in diabetes management. As a diabetes nurse consultant, she recognized the need for hospital nurses to increase their knowledge and confidence in managing issues related to insulin and glucose control. Nancy designed a program for bedside nurses that resulted in decreased incidences of hypoglycemia and insulin errors. Additionally, she designed and coordinated the implementation of a diabetes chronic conditions management program for a large HMO, training nurses to become diabetes care managers.

Nancy is a published author whose work includes the article “Diabetes Management in a Health Maintenance Organization: Efficacy of Care Management using group Cluster visits” in the Diabetes Care Journal. She is also a past winner of the research award from Kaiser Permanente, Northern California for the Diabetes Cooperative Care Clinic. Nancy presents on the national level and is a regular presenter for the UCSF program “Becoming a Diabetes Educator.”

Disclosures:

Financial: Nancy Moline has an employment relationship with Alta Bates Hospital. She receives an honorarium from Alameda County Health System; King Hooper Diabetes Education, Inc.; and University of California San Francisco Board of Nursing. Ms. Moline receives a speaking honorarium from PESI, Inc.

Nonfinancial: Nancy Moline is a member of the American Association of Diabetes Educators.