Facilitators and Barriers to Nursing Implementation of Continuous Glucose Monitoring (CGM) in Critically Ill Patients With COVID-19.
Facilitators and Barriers to Nursing Implementation of Continuous Glucose Monitoring (CGM) in Critically Ill Patients With COVID-19.
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DOI：
10.1016/j.eprac.2021.01.011
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Dungan K
中科院分区：
文献类型：
--
作者：
Faulds ER;Jones L;McNett M;Smetana KS;May CC;Sumner L;Buschur E;Exline M;Ringel MD;Dungan K
我们描述了我们在 2019 年冠状病毒病医疗重症监护病房 (MICU) 中实施的连续血糖监测 (CGM) 指南，以支持静脉注射胰岛素给药并减少护理点 (POC) 血糖监测频率，并使用促进卫生服务研究行动框架评估护士实施 CGM 和混合 POC + CGM 方案的经验。一个多学科团队制定了一份指南，提供了在每个患者体内建立初始传感器仪表协议的标准，然后混合使用 CGM 和 POC。在初始验证期间每小时获取一次 POC 测量值，然后每 6 小时获取一次。我们在 MICU 护士中建立了一个焦点小组，以评估最初的实施工作，其内容领域侧重于对证据、背景和促进因素的初步评估，以确定障碍和促进因素。使用定性描述方法对焦点小组进行分析。该协议通过快速周期审查流程进行整合，并最终在全国范围内传播。糖尿病咨询服务进行了设备设置，护士接受了及时培训。大多数障碍集中在背景因素上，包括物理环境的限制、复杂的设备设置、医院防火墙、培训需求和 CGM 文件。护士认为设备的准确性和实用性非常高。设计的解决方案旨在最大限度地提高护士的便利性和可持续性，同时维护患者的安全。门诊 CGM 系统可以使用混合协议实施科学方法在 MICU 中实施。这些努力具有巨大的潜力，可以减少医护人员的暴露，同时在 COVID-19 大流行期间保持血糖控制。
We describe our implementation of a continuous glucose monitoring (CGM) guideline to support intravenous insulin administration and reduce point of care (POC) glucose monitoring frequency in the coronavirus disease 2019 medical intensive care unit (MICU) and evaluate nurses’ experience with implementation of CGM and hybrid POC + CGM protocol using the Promoting Action on Research in Health Services framework. A multidisciplinary team created a guideline providing criteria for establishing initial sensor-meter agreement within each individual patient followed by hybrid use of CGM and POC. POC measures were obtained hourly during initial validation, then every 6 hours. We conducted a focus group among MICU nurses to evaluate initial implementation efforts with content areas focused on initial assessment of evidence, context, and facilitation to identify barriers and facilitators. The focus group was analyzed using a qualitative descriptive approach. The protocol was integrated through a rapid cycle review process and ultimately disseminated nationally. The Diabetes Consult Service performed device set-up and nurses received just-in-time training. The majority of barriers centered on contextual factors, including limitations of the physical environment, complex device set-up, hospital firewalls, need for training, and CGM documentation. Nurses’ perceived device accuracy and utility were exceptionally high. Solutions were devised to maximize facilitation and sustainability for nurses while maintaining patient safety. Outpatient CGM systems can be implemented in the MICU using a hybrid protocol implementation science approach. These efforts hold tremendous potential to reduce healthcare worker exposure while maintaining glucose control during the COVID-19 pandemic.
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