Diabetes Care in the Hospital 2018 Standards from the ADA

posted01-Oct-2018

At St. Dominic we follow the ADA Standards of Care. 

  • Insulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold ≥180 mg/dL (10.0 mmol/L). Once insulin therapy is started, a target glucose range of 140–180 mg/dL (7.8–10.0 mmol/L) is recommended for the majority of critically ill patients and noncritically ill patients.
  • A basal plus bolus correction insulin regimen, with the addition of nutritional insulin in patients who have good nutritional intake, is the preferred treatment for noncritically ill patients.
  • Prolonged* use of sliding scale insulin in the inpatient hospital setting is strongly discouraged

*poorly controlled blood glucose over 48 hours with sole use of correctly dose only

The use of subcutaneous rapid- or short-acting insulin before meals or every 4–6 h if no meals are given or if the patient is receiving continuous enteral/parenteral nutrition is indicated to correct hyperglycemia (2). Basal insulin or a basal plus bolus correction insulin regimen is the preferred treatment for noncritically ill patients with poor oral intake or those who are taking nothing by mouth (NPO). An insulin regimen with basal, nutritional, and correction components is the preferred treatment for noncritically ill hospitalized patients with good nutritional intake.

If the patient is eating, insulin injections should align with meals. In such instances, POC glucose testing should be performed immediately before meals. If oral intake is poor, a safer procedure is to administer the rapid-acting insulin immediately after the patient eats or to count the carbohydrates and cover the amount ingested (30).

A randomized controlled trial has shown that basal-bolus treatment improved glycemic control and reduced hospital complications compared with sliding scale insulin in general surgery patients with type 2 diabetes (31). Prolonged sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged

Glucocorticoid Therapy

Glucocorticoid type and duration of action must be considered in determining insulin treatment regimens. Once-a-day, short-acting glucocorticoids such as prednisone peak in about 4 to 8 h (59), so coverage with intermediate-acting (NPH) insulin may be sufficient. For long-acting glucocorticoids such as dexamethasone or multidose or continuous glucocorticoid use, long-acting insulin may be used (26,58). For higher doses of glucocorticoids, increasing doses of prandial and supplemental insulin may be needed in addition to basal insulin (60). Whatever orders are started, adjustments based on anticipated changes in glucocorticoid dosing and POC glucose test results are critical

Transition from the Acute Setting

An outpatient follow-up visit with the primary care provider, endocrinologist, or diabetes educator within 1 month of discharge is advised for all patients having hyperglycemia in the hospital. If glycemic medications are changed or glucose control is not optimal at discharge, an earlier appointment (in 1–2 weeks) is preferred, and frequent contact may be needed to avoid hyperglycemia and hypoglycemia.

All information directly from Chapter 14.  Diabetes Care in the Hospital: Standards of Medical Care in Diabetes -2018

American Diabetes Association

Diabetes Care 2018 Jan; 41(Supplement 1): S144-S151. https://doi.org/10.2337/dc18-S014

 

New Password Management for St. Dominic Providers

posted18-Jul-2017

As we prepare for our Cerner EMR implementation, we are rolling out new password guidelines to comply with BCBS and other Insurer's standards which are:

  • Must be at least 8 characters
  • Can not include any part of the username
  • Must not repeat any earlier passwords
  • Must have at least 8 letters/characters/numbers and have at least one uppercase letter, one lowercase letter and one number. The following characters are also accepted: ~!@#$%^&*_-+=`|\(){}[]:;”’<>,.?/
We have also added the self-service ability to manage passwords from outside the facility 24/7 using http://account.stdom.com. The instructions to manage passwords are attached below. Please make every effort to keep passwords as secure as possible. Thank you!

 Account Services User Onboard.v03

 

New Medical Record Documentation Requirements

posted14-Feb-2017

During their February meeting, the MEC endorsed the attached suspension timeline for medical record deficiencies based off of the new requirements set forth in the Medical Staff Bylaws as well as the Rules and Regulations. Beginning Monday, February 20th, Medical Records will begin using this timeline for monitoring deficiencies. 

Beginning March 1st Advanced Practice Providers (NPs and PAs) will also be required to complete their medical record deficiencies in accordance to these guidelines to avoid suspension of their clinical privileges. All Advanced Practice Providers are encouraged to complete any outstanding deficiencies ASAP to avoid suspension on March 1st. 

Under the new Medical Staff Rules and Regulations, the attending or supervising physician must review and authenticate all consultations and discharge summaries prepared by the Advanced Practice Professional (Rules & Regulations 3.16 & 4.9.6). Additionally, whenever an Advanced Practice Professional performs an H&P, either the H&P or the addendum written by the physician, must be signed by the physician (Rules and Regulations 4.9.6). Please note that these changes were made to ensure compliance with regulatory requirements. Due to these new requirements all Advanced Practice Professionals must dictate using their own provider ID# and must identify the physician in which they are dictating for. If you do not know your provider ID# please call 200-6846. 

Please feel free to contact Paula Lindsey, Director of Medical Staff Services at 601-200-6882 with any questions or concerns.

Deficiency Suspension Timeline