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The Perinatal unit at UC Irvine Medical Center lacked a standardized protocol for diabetic patient teaching. A patient admitted for diabetic control is generally hospitalized for 3 to 5 days.  At the time of discharge the patient is expected to know how to use the glucose meter, the signs and symptoms of low blood sugar, appropriate diet, how to draw up and self administer insulin.  Too often patients did not have the appropriate teaching when it came time for their discharge.  Even one patient claiming not to know how to give herself insulin is one too many. 

Goal:

Our goal was to develop a diabetic teaching plan to assist nurses in better diabetic teaching strategies to improve patient understanding of their own diabetic care.  This program developed a 3-day teaching plan for insulin dependent diabetics. 

Process:

1.  We attended a Sweet Success Conference to ensure our teaching was current. 

2.  We developed a questionnaire for the patient to complete before implementing the teaching plan and upon completion.  The questionnaire included the patient’s learning needs, readiness to learn, and learning preferences.  It also served as a means for establishing a baseline for patient knowledge and a way to document learning. 

3.  We created a 3 day teaching plan that included:

Day 1-

• Give patient & teach her how to use glucose meter 
• Give patient hand out listing the signs & symptoms of low blood sugar
• Have patient repeat S&S of low blood sugar 
• Request nutritional consult 
• Give patient the Diabetes Education DVD. 

Day 2-

• Review Day 1 
• Follow-up on nutritional consult 
• Give patient “Getting Started Take Home Kit” 
• Teach patient how to draw up insulin and how to give subcutaneous injection 
• With the RN’s assistance, have her draw up and give insulin at least three times 
• When patient states confidence, have her demonstrate skills with RN’s supervision

Day 3-

• Review Day 1 and Day 2  
• Fax patient’s prescription to pharmacy
• Pick up patient’s medications from pharmacy
• Review medication regimen
• Have patient state signs & symptoms of low blood sugar & how to monitor blood sugar with glucose meter
• Have patient demonstrate drawing up and giving insulin
• Make patient’s follow-up appointment

4.  We also created a check off list for the nurses to use.  This kept them accountable for each day’s learning activities.

5.  We produced the DVD to use in the teaching process.  The DVD allowed patients to learn at their own pace and the repetition strengthened learning and was important for new knowledge and skills. 

6.  We provided in-service to all perinatal nurses.  This included a review of the Sweet Success guidelines, the check off list, glucose meter operations, and additional patient handouts. 

7.  During our implementation phase we were available to assist RN’s and reminded them to utilize the check off list. 

8.  Finally, we evaluated the success of our program and found consistent patient teaching, improvement in demonstrated techniques, and increased awareness and understanding.