Papers by patricia linekin
The Joint Commission Journal on Quality Improvement, 1995
The goal of this study was to establish a continuous quality improvement (CQI) program for diabet... more The goal of this study was to establish a continuous quality improvement (CQI) program for diabetes which would identify patterns in the problems of care encountered by hospitalized patients with diabetes and improve the in-hospital process of diabetes care delivery. The laboratory information system in an acute and tertiary care 1,000-bed urban teaching hospital provided us on a daily basis with a list of patients on the medical service having blood glucose (BG) levels < 40mg/dl or > 450mg/dl and positive serum acetones. We performed concurrent implicit chart review when BG levels were hypoglycemic (< 40mg/dl) or hyperglycemic (> 450mg/dl on two occasions) or when diabetic ketoacidosis (DKA) was present (acetones were > 1+) using preset indicators for documentation and appropriate medical management. Data were expressed as the ratio of number of cases in compliance with the indicator over total number of cases identified. A test for trend in proportions was used to assess compliance with the indicators over time. Documentation of nursing unit-based capillary blood glucose (CBGM) and insulin infusion monitoring improved significantly over time (p < 0.001 for both). The medical management of hypoglycemia, hyperglycemia and DKA improved (p = 0.1) over the three-year period. Identification of recurrent multidisciplinary process problems in the management of DKA, intravenous insulin infusion constitution and delivery, CBGM determination in the setting of anemia, and recognition of clinical settings conducive to the development of hypo- and hyperglycemia were identified and addressed with standardization in documentation, an insulin infusion protocol, administrative rules, and staff education. Efforts to standardize specific clinical and documentation processes had a positive impact on the care of hospitalized patients with diabetes and resulted in an institutional effort to improve inpatient diabetes care with a CQI team.
Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 2002
Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 2002
Technological advances in home blood glucose monitors have no practical value unless the test res... more Technological advances in home blood glucose monitors have no practical value unless the test results are recorded and used for pattern management. This systematic approach is central to the plan of care for patients with diabetes. Pattern management helps patients, caregivers, and referring physicians identify patterns in blood glucose readings, so treatment and/or lifestyle changes can be made without delay.
Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 2001
An American Diabetes Association-funded study (Roman, Haddow, & Chassin, 1997) found that diabete... more An American Diabetes Association-funded study (Roman, Haddow, & Chassin, 1997) found that diabetes is rarely a focus of care for patients with diabetes when they require hospitalization for other conditions. The diagnosis of diabetes may not even be included in the hospital records of patients with diabetes.
Home HealthCare Nurse: The Journal for the Home Care and Hospice Professional, 2001
Why is it that a diagnosis of diabetes results in higher reimbursement for a home care agency, ye... more Why is it that a diagnosis of diabetes results in higher reimbursement for a home care agency, yet no OASIS questions assess diabetes? This is especially troubling because the referral to home care is usually prompted by the need for skilled nursing care for complications of uncontrolled diabetes (e.g., cardiac disease, non-healing wounds, ulcers, infection). These conditions will not improve unless glycemic control is achieved. With the ever-present pressure for productivity of nursing staff, I wonder how often diabetes is appropriately addressed with any patients. Presently there are no official home care diabetes standards of care; however, definite standards for diabetes care and education are in place from the American Diabetes Association.
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Papers by patricia linekin