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Aurora St. Luke’s Medical Center

Presentation Notes

Evidence-Based Practice podium presentation at Nursing Passion: Re-Igniting the Art & Science, Advocate Aurora Health Nursing & Research Conference 2022; November 9, 2022; virtual.


Background: Multiple episodes of severe hypoglycemia occurred in inpatient hospice patients with type 2 diabetes (T2DM) at Aurora Zilber Family Hospice (“Zilber”). Chart audits indicated the diabetic care provided was inconsistent with best practice; surveys of nursing staff demonstrated knowledge deficits in management of hospice patients with T2DM. Changes caused by terminal illnesses alter the pharmacokinetics of diabetic medications, leading to erratic and symptomatic blood glucose excursions (ADA, 2020). Improper management of diabetic hospice patients causes burdensome symptoms and suffering, but providing appropriate care is challenging (Dionisio et al, 2015; Mitratza et al., 2020; Smyth & Smyth, 2011).

Purpose: To improve the care of Zilber patients with T2DM by answering the PICOT question: does implementation of a clinical decision-making assistance tool for T2DM, compared to standard practice, improve nurses’ knowledge of T2DM management and perceived quality of care for hospice patients with T2DM, and does it decrease the frequency of hypoglycemic events?

Implementation: An evidence-based clinical decision-making assistance tool to guide multiple aspects of type 2 diabetic care in hospice patients (glucose monitoring, medications, patient education) was developed and customized for Zilber patients and care practices. Nurses received education on T2DM in hospice and the use of this tool. Pre- and post-education chart audits and nurse surveys assessed project impact.

Outcomes: Descriptive statistics and paired t-tests were used to compare results of audits and surveys. Audits revealed some improvement to diabetic care and no episodes of hypoglycemia, although opportunities for improvement persist. Surveys showed a statistically significant increase in staff knowledge (p=0.02) and perceived quality of T2DM care (p=<0.001).

Implications for practice: Staff education and use of a customized tool to guide diabetic care for hospice patients improved patient care. The tool could be extended to other hospice settings to improve quality of care received by patients with T2DM.

Document Type

Oral/Podium Presentation




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