Improving nursing management of patients with diabetes using an action research approach

Nurses in an acute hospital implemented an action research process supporting changes to the assessment and management of acutely ill patients admitted with diabetes and other co-morbidities. An audit of practice identified inaccurate documentation and uncoordinated care that included inflexible protocols for blood glucose level (BGL) assessment and administration of insulin, unrelated to patients' meals and snacks, that in some instances resulted in hypoglycemic episodes. Specialist nurses and ward staff collaborated to improve practice by increasing nurses' knowledge of insulin and by designing and trialing a blood glucose monitoring form that enabled a more individualised approach to patient care. A subsequent audit showed improved coordination of BGL measurement and insulin administration in relation to meals, sustained over eighteen months, and increased accuracy in documentation.