Preferred Name
Julia D. Burgess
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
ORCID
0009-0005-3024=9653
Date of Graduation
12-13-2025
Semester of Graduation
Fall
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
First Advisor
Jeannie Corey
Abstract
Abstract
The management of inpatient glycemia, including both diabetic patients and those with illness-related dysglycemia, is now recognized by the Centers for Medicare & Medicaid Services as an electronic clinical quality measure (eCQM) (CMS, 2024a). Hospitals are voluntarily reporting hyper- and hypoglycemia rates in preparation for mandatory reporting, which is set to begin in 2026, and potential future financial penalties. The purpose of this quality improvement project was to reduce elapsed time from bedside glucose testing to insulin administration around patient mealtime (the meal triad) by implementing nursing workflow changes to eliminate barriers and reduce inefficiencies.
There is limited literature describing nursing’s contribution to inpatient glycemic management; however, missed and delayed nursing care is recognized as contributing to adverse patient outcomes and patient safety. This project was implemented in an 183-bed northern Virginia hospital on the medical-surgical units, which comprised a total of 100 inpatient adult beds. A bundled group of interventions was implemented, that included the reassignment of responsibility for the glucose check from unlicensed assistive personnel (UAP) to the patient’s registered nurse (RN), increasing glucose meters to allow for one meter per clinician, allowing one vial of insulin lispro to be kept in the patient’s locked medication cabinet, eliminating the independent double-check for insulin lispro, and creating testing and insulin administration supply kits for each clinician. Over 4,000 elapsed times (from glucose test to insulin administration) were compared before and after the intervention. Before the intervention, 32% of the elapsed time was completed within 30 minutes, and 52% within 45 minutes. Following implementation of the bundle of nursing workflow changes, 87% of elapsed times were within 30 minutes, and 93% were within 45 minutes (p < .001). This project demonstrates that eliminating nursing workflow barriers can reduce delays in patient care for hospitalized patients requiring glycemic management and achieve recommended goals for insulin administration, potentially impacting future financial penalties. The project was implemented in collaboration with another Doctor of Nursing Practice student’s project, designed to improve communication workflows and dietary efficiency, both contribute to glycemic management.
