Comprehensive program increases recognition and treatment of steroid-induced hyperglycemia

On average one of every five oncology patients will experience hyperglycemia, particularly when placed on glucocorticosteroid therapy as part of their chemotherapy program. In a large academic medical center, where 75% of hematology-oncology adult patients receiving induction or consolidation therapy are also receiving glucocorticosteroids, time used for monitoring, managing, and teaching self-care can be overwhelming.

To ensure consistency in staff practices and delivery of patient education, areas of educational need were identified among staff. The educational focus was streamlined to provide a comprehensive program that promoted both staff and patient engagement in understanding steroid-induced hyperglycemia (SIH), Danielle Pohlen, RN, BSN, Inpatient Hematology Oncology, Duke University Medical Center, Durham, North Carolina, and colleagues reported at the Oncology Nursing Society 36th Annual Congress.

A multi-phased educational program was designed to increase staff knowledge on the development of SIH, promote implementation of evidence-based practices, and expand patient education materials. Half of the staff completed a presurvey that examined staff knowledge and practices. The survey results identified areas that needed improvement such as identifying patients at risk for developing SIH, initiating an SIH plan of care, notifying health care providers promptly of changes in SIH control, and providing patient education on SIH management while hospitalized. In-services were then held to present current evidence-based practice guidelines for management of hyperglycemia; discuss responses to the survey; delineate areas for improvement; and address mechanisms to engage patients and family in self-care of hyperglycemia for home management.

The evidence-based practice (EBP) plan of care on SIH was displayed on a bulletin board placed in a prominent viewing area for staff. In addition, a diabetes and SIH educational folder was created that included other unit-specific educational documents. The patient-education brochure included commonly asked questions and care guidelines.

A postsurvey was administered to evaluate changes in staff knowledge and practices, Pohlen noted, with results reviewed during lunch-and-learn sessions. These results found the staff had increased their knowledge, more consistently performed EBP guidelines, were able to address patient questions better, and exhibited trends toward improving early initiation of a hyperglycemia care plan and promoting patient engagement for self-care earlier in a patient's hospitalization.

Subsequent in-services reinforce practice guidelines, including placing Key Hyperglycemia Points at each nursing station and developing a hyperglycemia care plan template. Future plans include initiating a SIH care plan and patient education for impact of care.

“Through implementation of a multi-phased intervention, we were able to adapt interventions based on staff and patient needs,” concluded the researchers. “Thus, sustained changes in practice for a greater impact on patient outcomes can be achieved.”
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