Hyperglycemia Vs Diabetic Ketoacidosis Protocols Clinical Paper

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Hyperglycemia VS Diabetic Ketoacidosis Protocols Clinical Paper
Lindsey Tesorero
Sacred Heart University
April 22, 2015

Instructor: Professor Yost
At Yale New Haven on the medicine floor SLA 4, the nurse manager identified the need of education on both the hyperglycemia and diabetic ketoacidosis protocols. The nurses and doctors were not aware of the steps outlined in the protocol that needed to be followed. There have been several incidents across the hospital of orders not being correctly prescribed by physicians and nurses following through with these incorrect orders, therefore seriously effecting patient outcomes. Specifically on SLA 4 there was a recent incidence of a patient coming off of an
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In the instance on SLA 4, the orders were not correct for switching the hyperglycemic patient coming off the insulin drip to subcutaneous insulin. It is stated in the protocol that a patient must always be transitioned to subcutaneous insulin when coming off of an insulin drip; however, the protocol can be difficult to follow causing information to be missed. Since the nurse did not catch the mistake in the doctor’s order the patients’ blood sugar ended up shooting up to a very high level again. This adverse effect easily could have been prevented if the nurse realized that since the patient came off an insulin drip he needed to be getting insulin shots. Even though it is the physician’s job to write the orders, the nurse always has to double check them because they are the last line before the orders are followed through. If these orders are not correct then it is not only the fault of the physician, but of the nurse as well. This tool will help to prevent adverse effects in many ways. The protocols for both crises are long and information can be lost or easily overlooked. By having a tool that clearly states the important orders that need to be followed in a clear step by step course of action eliminates this factor. In a study of patients who were in a hyperglycemic crisis, it was found that when a protocol for hyperglycemia was used to treat the patient there was a 9.2 hour decrease in the amount of time it took to resolve. In comparison, the
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