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Timing Is Everything: Results to an Observational Study of Mealtime Insulin Practices

Lampe, Julie MSN, CNS, CNS-BC, ADM-BC; Penoyer, Daleen Aragon PhD, RN, CCRP, FCCM; Hadesty, Shannon BSN, RN, CNRN; Bean, Angelina MSN, RN, CNL, PCCN; Chamberlain, Lyne MSN, CNS, CCNS

Clinical Nurse Specialist:
doi: 10.1097/NUR.0000000000000045
Feature Article
Abstract

Purpose: The purpose of this study was to evaluate the timing and practices of blood glucose testing and rapid-acting insulin administration around mealtimes.

Design: This study used an observational, descriptive design to assess the time between blood glucose testing and insulin administration and the time between first bite of the meal and insulin administration.

Setting: The setting was 4 cardiology units in 2 hospitals within a large community healthcare system.

Sample: Sixty-four mealtime practice events at breakfast, lunch, and supper were observed.

Methods: Investigators directly observed the timing of rapid-acting insulin administration at 3 mealtime periods an assessed timing of blood glucose testing, food intake, and method of glucose reporting.

Results: Overall, 14% (n = 64) of the patients received blood glucose testing within 1 hour prior to insulin administration and insulin administration within 15 minutes of the meal. As separate elements, blood glucose testing was done within the defined ideal range 35% (n = 63) of the time, and insulin was administered within range 40% (n = 58) of the time.

Conclusions: Timing for meals, blood glucose testing, and rapid-acting insulin administration varied significantly and was not well synchronized among the various patient caregivers with low achievement of ideal practices.

Implications: Results to this study revealed opportunities for better coordination of mealtime insulin practices. Lack of coordination can lead to medication errors and adverse drug events. Further study should include effect of mealtime coordination on glycemic control outcomes and testing the effect of interventions on timing of mealtime insulin practices.

Author Information

Author Affiliations: Diabetes Clinical Nurse Specialist (Ms Lampe), Orlando Regional Medical Center, Director Center for Nursing Research (Dr Penoyer), Orlando Health, Clinical Nurse–Neurology (Ms Hadesty), Orlando Regional Medical Center, CNL, Cardiac Progressive Care Unit, Orlando Health (now Assistant Professor of Nursing, Adventist University of Health Sciences) (Ms Bean), and Heart Failure Clinical Nurse Specialist, Dr P. Phillips Hospital (now Professor of Nursing, Seminole State College), Altamonte Springs (Ms Chamberlain), Florida.

The authors report no conflicts of interest.

Correspondence: Julie Lampe, MSN, CNS, CNS-BC, ADM-BC, Orlando Regional Medical Center, 1414 Kuhl Ave, Orlando, FL 32806 (Julie.lampe@orlandohealth.com).

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins