A quality improvement project for better glycemic control in hospitalized patients with diabetes.

PURPOSE: A quality improvement (QI) study was designed to improve nursing interventions that impact glycemic control in hospitalized patients with diabetes. The objective was to improve the timing of premeal insulin to allow a half hour lag time for regular insulin. METHODS: An interdisciplinary planning team was established that included both medical and surgical units. Data were collected by concurrent review of electronic charts, evaluated monthly by management and the diabetes clinical coordinator, and shared with staff. RESULTS: This QI study increased staff nurses' awareness of the importance of their role in achieving better glycemic control for inpatients with diabetes. By the end of the study, the nurses delivered premeal insulin correctly 82% of the time on the medical unit, 65% of the time on the cardiac unit, and 61% of the time on the surgical unit. Even with concerted effort, however, it was difficult to consistently administer regular insulin with a half hour lag time in the hospital environment. CONCLUSIONS: By working together with the patient, family, and other staff, nurses can more consistently deliver premeal insulin at appropriate times to help improve glycemic control in the hospitalized patient with diabetes.

Prenatal diagnosis by amniocentesis in 800 pregnancies.

Prenatal diagnoses by amniocentesis have been made in 800 pregnancies at the Genetics Division of the Los Angeles County-University of Southern California Medical Center. This experience has indicated that the amniocentesis procedure is safe and highly accurate. Amniocentesis was not associated with significant morbidity or mortality for either infant or mother. The observed complications are assumed to be related to the high-risk nature of these pregnancies, the patients having been selected primarily on the basis of advanced maternal age or a previous abnormal child. The needle puncture marks, which occurred in 2.4 percent of the live births, resulted in no serious developmental or cosmetic effects to the infants. No errors in cytogenetic diagnosis are known to have occurred in this series.