Staff Nurse Facilitators and Barriers for Diabetes Practice Guidelines

Abstract

Introduction: The management of diabetes and achievement of blood glucose goals for hospitalized patients is complex due to numerous variables. National guidelines with an intra-professional approach have been developed and include blood glucose goals as well as the use of scheduled basal and pre-meal insulin dosing (Umpierrez, et al., 2012). At Grant Medical Center (GMC), protocols have been developed and implemented to incorporate the national guidelines with the leadership of an intra-professional diabetes care committee. Methods: This project used a focus group discussion format to assess nurse perceptions of the national guidelines as well as to identify facilitators and barriers for implementation of the guidelines. Results: The overarching areas of facilitators and barriers each included categories of nurse factors, patient factors, prescriber factors, treatment factors and DM meal factors. Nurses shared that staff education, the availability of diabetes educators and pre-printed orders facilitated guideline use; while, the on demand meal process, dietary non-adherence and variations in prescriber practices were barriers to guideline use. Conclusions: There are gaps in the implementation of national guidelines for hospitalized persons with diabetes. Overcoming the barriers and cultivating the facilitators can improve care processes and patient outcomes. This project identified areas of opportunity for additional staff and patient education as well as processes that can be improved, e.g., the on demand meal process and the pre-printed order sets.