Magazine article American Nurse Today

Taking Steps in the Hospital to Prevent Diabetes-Related Readmissions

Magazine article American Nurse Today

Taking Steps in the Hospital to Prevent Diabetes-Related Readmissions

Article excerpt

Despite the growth in scientific advances in management, diabetes continues to be a chronic disease plagued by frequent hospital readmissions. Patients with diabetes account for approximately 480,958 hospital in-patient stays per year with a 30-day readmission rate of 97,784, accounting for a 20.3% hospital readmission rate.

Given these statistics, it's not surprising that reducing readmission rates for patients with diabetes has become an important goal for hospitals and healthcare providers. And, given the number of people who will be diagnosed with diabetes in the future, emphasis on that goal is only likely to increase. Consider that currently 26 million people in the United States (8.3% of the population) have diabetes, and another 7 million people have undiagnosed diabetes. Estimates indicate an additional 2 million people 20 years and older are diagnosed with diabetes each year. Finally, estimates of people at risk for diabetes or people with pre-diabetes are approximately 79 million.

As a nurse, you play a pivotal role in reducing readmission rates by participating in team initiatives related to patient education and self-management and by ensuring that preventing readmissions is addressed early during the hospital stay.

It takes a team

Preventing diabetes-related hospital readmissions takes a multidisciplinary team that includes registered nurses, nurse practitioners, physicians, physician assistants, registered dietitians, pharmacists, social workers, nursing assistants, and certified diabetes educators (CDEs). (See About certified diabetes educators.) The team helps educate patients, serves as a resource to staff, and collaborates with other healthcare providers.

Nurses can partner with other members of the team to ensure patient needs are met. For example, pharmacists can provide a Diabetes Discharge Kit, an individualized kit that might include a home monitoring diary, educational materials, insulin materials if needed, and medication reconciliation information; social workers can coordinate home health care as needed and obtain prior authorization for supplies. Staff nurses can assess a patient's skill and knowledge and provide instruction on diabetes management and complications.

Coordination of the interprofessional team by the primary care provider is important in discharge planning and preventing readmissions.

Start early

Actions to prevent readmission should begin when the patient is admitted to the hospital and reevaluated as patient care needs change. Early discharge planning is particularly important for high-risk patients such as those who:

* have elevated glucose levels or poor glycemic control

* have been newly diagnosed as having diabetes

* are starting insulin therapy

* have comorbidities

* had a recent hospital admission for diabetes ketoacidosis (DKA) or hypoglycemia

* have a readmission diagnosis of hypoglycemia or hyperglycemia.

The multidisciplinary team must evaluate preadmission factors that can affect patient needs during hospitalization and after discharge, including:

* functional abilities or limitations

* economic factors, such as lack of health insurance or inability to afford prescriptions

* follow-up access to care (ensuring that patients have a primary care provider for follow up)

* barriers to learning, such as language and motor skills

* how well diabetes was controlled before hospital admission

* readmission within 30 days of a previous admission

* comorbid conditions

* psychosocial evaluation primarily for depression, a common problem in patients with diabetes.

Admission assessments should include blood glucose and A1C. Glycemic control strategies should be implemented early in the hospital stay to attain optimal outcomes when ready for discharge. …

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