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The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study.

Publication ,  Journal Article
Evans, KJ; Thompson, J; Spratt, SE; Lien, LF; Vorderstrasse, A
Published in: Adv Emerg Nurs J
2014

This retrospective observational quality improvement study was conducted to determine whether an evidence-based protocol for the treatment of diabetic ketoacidosis improved patient outcomes in our academic medical center. This study evaluated fidelity of providers to the protocol, as well as time to resolution of diabetic ketoacidosis as measured by closure of the anion gap (AG). Other secondary outcomes included time to intravenous fluids, time to potassium replacement, and rates of hypoglycemia and hypokalemia.Two cohorts including historical (N = 41) and current (N = 37) were compared to evaluate the effectiveness of the protocol. There were no differences between group demographics at baseline. After implementation of the protocol, 43.2% of patients were treated using full protocol fidelity, 21.6% were treated with partial fidelity, and 35.1% were not treated using the protocol. Although none of the outcomes reached statistical significance, patients in the current group who were treated with full protocol fidelity had an average time to AG closure that was 3 hr less than those who were not treated according to the protocol, and an average time to potassium replacement that was 2 hr less. When comparing the historical cohort with the patients treated with full protocol fidelity, there was improvement in protocol-treated patients in time to AG closure (2 hr), time to dextrose replacement (1.7 hr), and time to potassium replacement (2 hr). The rates of hypokalemia were improved with protocol treatment; 37.5% of protocol-treated patients had hypokalemia as opposed to 63.4% of those not treated according to protocol.Overall, despite the low fidelity in our institution, the protocol promoted evidence-based practice and patients treated according to the protocol had decreased time to treatment outcomes including quicker AG closure, improved intravenous fluids resuscitation, and more accurate and timely electrolyte correction.

Duke Scholars

Published In

Adv Emerg Nurs J

DOI

EISSN

1931-4493

Publication Date

2014

Volume

36

Issue

2

Start / End Page

189 / 198

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Quality Improvement
  • Middle Aged
  • Male
  • Humans
  • Female
  • Evidence-Based Medicine
  • Diabetic Ketoacidosis
  • Cohort Studies
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Evans, K. J., Thompson, J., Spratt, S. E., Lien, L. F., & Vorderstrasse, A. (2014). The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study. Adv Emerg Nurs J, 36(2), 189–198. https://doi.org/10.1097/TME.0000000000000021
Evans, Kathryn J., Julie Thompson, Susan E. Spratt, Lillian F. Lien, and Allison Vorderstrasse. “The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study.Adv Emerg Nurs J 36, no. 2 (2014): 189–98. https://doi.org/10.1097/TME.0000000000000021.
Evans KJ, Thompson J, Spratt SE, Lien LF, Vorderstrasse A. The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study. Adv Emerg Nurs J. 2014;36(2):189–98.
Evans, Kathryn J., et al. “The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study.Adv Emerg Nurs J, vol. 36, no. 2, 2014, pp. 189–98. Pubmed, doi:10.1097/TME.0000000000000021.
Evans KJ, Thompson J, Spratt SE, Lien LF, Vorderstrasse A. The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study. Adv Emerg Nurs J. 2014;36(2):189–198.

Published In

Adv Emerg Nurs J

DOI

EISSN

1931-4493

Publication Date

2014

Volume

36

Issue

2

Start / End Page

189 / 198

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Quality Improvement
  • Middle Aged
  • Male
  • Humans
  • Female
  • Evidence-Based Medicine
  • Diabetic Ketoacidosis
  • Cohort Studies
  • Adult