The Diabetes, Obesity, and Nutrition Strategic Clinical Network (DON SCN) is leading a provincial initiative: with the goal of improving and standardizing how patients with diabetes are cared for in Alberta’s hospitals.
This is a multipronged quality improvement initiative, in collaboration with AHS provincial Pharmacy, AHS provincial Nutrition and Food Services, and the Zone operational areas. It involves a multidisciplinary approach (with many different health care providers) to diabetes management, with the patient and family as key team members.
1 in 5 adult patients admitted to hospital in Alberta has diabetes. When compared to their non-diabetic counterparts, patients with diabetes have longer hospital stays. Provincially, the average length of stay among patients with diabetes was 5 days, which is two days longer than the average length of stay among non-diabetics.
The inpatient diabetes management initiative is a priority for the DON SCN because hyperglycemia continues to be common in hospitals and increases the risk of complications including: post-operative infections, pneumonia, diabetic ketoacidosis (DKA), and delays wound healing.
Literature suggests that patients with diabetes experience hyperglycemia (high blood sugar) 38 per cent of the time they are in hospital. Alberta data is consistent with this figure.
Improving blood sugar control in hospital has been associated with shorter length of stay in hospital and decreased rates of readmission. National Guidelines recommend blood glucose targets of 5-10 mmol/L for most patients with diabetes in hospital. Blood glucose targets of 5-12 mmol/L are recommended in the frail elderly, those with limited life expectancy and those at risk for severe hypoglycemia (e.g. hypoglycemia unawareness). See more information in the Diabetes Canada (previously the Canadian Diabetes Association) Clinical Practice Guidelines (CPGs) for In-Hospital Management of Diabetes.
One of the initial priorities of the overall initiative is the implementation of Basal Bolus Insulin Therapy (BBIT), building upon work started in the province, and also implemented in other hospitals across the country.
The Safe Management of Insulin Pump Therapy (IPT) in Hospitals is another priority of the initiative.
Other areas of focus include:
The following assessments of current state were conducted to help guide our direction and priorities: