Patient Understanding of Discharge Instructions for Home Diabetes Self-Management and Risk for Hospital Readmission and Emergency Department Visits.

OBJECTIVE: The primary objective of this study was to examine the patient comprehension of diabetes self-management instructions provided at hospital discharge as an associated risk of readmission. METHODS: Noncritically ill patients with diabetes completed patient comprehension questionnaires (PCQ) within 48 hours of discharge. PCQ scores were compared among patients with and without readmission or emergency department (ED) visits at 30 and 90 days. Glycemic measures 48 hours preceding discharge were investigated. Diabetes Early Readmission Risk Indicators (DERRIs) were calculated for each patient. RESULTS: Of 128 patients who completed the PCQ, scores were similar among those with 30-day (n = 31) and 90-day (n = 54) readmission compared with no readmission (n = 72) (79.9 ± 14.4 vs 80.4 ± 15.6 vs 82.3 ± 16.4, respectively) or ED visits. Clarification of discharge information was provided for 47 patients. PCQ scores of 100% were achieved in 14% of those with and 86% without readmission at 30 days (P = .108). Of predischarge glycemic measures, glycemic variability was negatively associated with PCQ scores (P = .035). DERRIs were significantly higher among patients readmitted at 90 days but not 30 days. CONCLUSION: These results demonstrate similar PCQ scores between patients with and those without readmission or ED visits despite the need for corrective information in many patients. Measures of glycemic variability were associated with PCQ scores but not readmission risk. This study validates DERRI as a predictor for readmission at 90 days.

The importance of normoglycemia in critically ill patients.

Hyperglycemia is a risk factor for adverse outcomes in acutely ill patients with and without diabetes. One third of all patients admitted to tertiary care facilities have hyperglycemia, with approximately 12% having had no prior history of diabetes. Hyperglycemia adversely affects fluid balance, predisposes to infection, morbidity following acute cardiovascular events, and increases the risk for renal failure, polyneuropathy, and mortality in ICU patients. Because traditional thought suggests hypoglycemia presents a more serious risk to critically ill patients than does hyperglycemia, clinicians are often less than aggressive in treating blood glucoses under 200 mg/dl. Current research, however, demonstrates that even modest degrees of hyperglycemia are associated with adverse outcomes in critically ill patients. Safe implementation of normoglycemia in intensive care patients can be labor intensive and requires well-formulated treatment strategies and interdisciplinary support. Therefore, understanding the importance of intensive glucose control, being comfortable with current clinical treatment modalities, and having the necessary resources to provide this type of care, are vital to critical care nursing practice today.