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Translational Research for Practice & Populations Enrico Silvestre Giron Western Governors University TRANSLATIONAL RESEARCH 2 Translational Research for Practice & Populations Natividad Trauma Center provides care for a very diverse population in Salinas, California. Predominantly an agricultural underserved population, diabetes is prevalent among the demographic served within this small community. Consequently, Natividad provides a wide range of educational programs for the community and hospital staff—namely, the Diabetes Education Program. The Diabetes Education Program serves both the inpatient and outpatient functions at Natividad. For example, a patient may be admitted to the inpatient setting with a diagnosis of diabetes and will be provided care according to the diabetes protocol utilized by the facility. Upon discharge, the patient will also be referred to the Diabetes Education department as well as their primary physician for follow-up continuity of diabetes management in the outpatient setting as well. Controlling blood glucose levels in the inpatient adult setting is an essential part of the management of diabetes. Countless studies have demonstrated that the achievement of euglycemia during the course of a hospitalization is difficult, especially given the time variations of blood glucose monitoring, meal tray delivery, and the administration of insulin. Nursing Practice Identification The current nursing practice at Natividad Trauma Center that is requiring change is the blood glucose monitoring protocol for those patients requiring before meals and at bedtime sliding scale coverage. Of particular interest, is the blood glucose monitoring performed at 0630 by the night shift, to be communicated during bedside report to the morning shift nurses by 0700. Nursing Practice Description When a patient is admitted to the inpatient setting with a diagnosis of diabetes and is requiring sliding scale coverage before meals and at bedtime, nurses assess the patient’s capillary TRANSLATIONAL RESEARCH 3 blood glucose at 0630, 1130, 1730, and 2100, respectively. Being an RN on the night shift, checking blood glucose at 0630 to report to the day shift RN at 0645, in theory, does not pose such a quandary—with the assumption that a patient will be receiving their breakfast tray and insulin within the next 15 minutes of the hand off report. However, with breakfast times ranging from 0800 to 0830, the dilemma lies in the accuracy of that 0630-blood glucose taken over an hour ago, relative to the sliding scale insulin dose prescribed. Also, work flow in any healthcare setting can be unpredictable. Sometimes, meal trays are delivered to the patient’s room without the RN being aware, and the patient may begin eating their meal before the RN can administer the insulin dose. Why Nursing Practice Needs to Change A fundamental aspect of medication administration is that the Registered Nurse will perform the necessary assessments to ensure overall safety and effectiveness of the medication for all patients. In theory, the RN assessing the blood glucose level, should be the RN administering the prescribed amount of insulin. At Natividad, the night shift RN will check the blood glucose at 0630, only for the day shift RN to administer the insulin by 0800. The accuracy of the 0630-blood glucose reading may be in question because a patient’s blood glucose level can drastically change within one hour of it being checked. Safety is an issue in this instance because the day shift nurse would be administering the prescribed amount of insulin for a 0630- blood glucose reading, which may be significantly higher than the current level would be at 0800 since the patient has not had breakfast yet. Chandler (2018) purports a “mismatch in the amount of insulin given to patients and lax nutritional standards,” have been associated with adverse clinical outcomes for hospitalized patients. TRANSLATIONAL RESEARCH 4 Per Natividad protocol, the insulin must be administered by the RN within thirty minutes before the patient begins eating, however, according to Chandler (2018) studies have shown that insulin should be administered within the first bite of the meal. As previously discussed, the day shift RN is the nurse administering the insulin. Work flow sometimes interrupts the appropriate time insulin is administered, and the actual meal is given—which demonstrates the “mismatch in amount of insulin given,” in relation to the time the blood glucose was checked, and meal tray was provided (Chandler, 2018). This practice must be altered with the patient’s safety at the forefront, as the risk for nosocomial hypoglycemia increases with this current practice. According to Ballin (2016), a hypoglycemic event “may lead to a number of complications, including accidents and falls, unconsciousness, seizures, cardiac event, and death.