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“The Effect of Diabetes on Hospital Readmission” discusses the effect of a diabetes diagnosis on hospital readmission and ways to decrease potential readmissions. A large study of hospitals also showed that being Hispanic, along with hypertension and congestive heart failure, were additional predictors of readmission. Higher HbA1C and glucose levels were strongly correlated to readmission for congestive heart failure, showing that glucose control can be a contributing factor to this chronic condition.
The first way the article listed to decrease readmissions is by reinforcing glycemic control and self-care in the hospital early in the hospital stay. Rather than waiting until the patient is about to leave to educate, educating from the beginning of their stay through demonstration of taking their blood sugar, appropriate interventions, and picking meals is much more effective.
The next intervention the article suggests is just to ensure that the diagnosis of diabetes is included in the discharge data because one study showed a significant correlation between hospital readmission and not listing diabetes in discharge data. Additionally, ensuring that physicians and the care team evaluate the medications that the patient has been taking, is taking at the hospital, and is sent home on. Patients are often sent home on the medications that they came to the hospital on, which for patients with diabetes may not be an effective regimen if their hospitalization is due to a complication of diabetes.
The last intervention the article suggests is utilizing inpatient and post discharge support teams. One study cited showed that an outpatient program that supported patients post-discharge with free access to insulin, phone support, and frequent check ins were less likely to be readmitted than those without the support program.
Our patient falls into many of the categories that is listed in the article as being high indicators for readmission after her discharge. Since discharge planning starts as soon as a patient is admitted, it would be important as her nurse to being educating about diabetes as soon as she is admitted and also demonstrate and explain why it’s important that we are regularly checking her blood sugar, giving insulin when needed, and helping her to pick healthy diet choices for her meals. Since she does not seem to follow a varied diet at home it would be important to help her pick healthy options and educate her how she could follow these plans at home. The patient’s medical team should also evaluate her home medications, as her frequent and sever infections, along with her blood glucose, indicate that her glucose is not being appropriately controlled. A quick search on her medications revealed that furosemide could affect diabetes control, so this could be something that may need to be evaluated of the risk versus benefits, as well as possible alternative medications to replace the furosemide. Finally, making a referral for our patient to post discharge support for her diabetes shows to be beneficial. Depending on the hospital and community it could be an established education program or referral to a registered dietician to help with concerns about her diabetes management when she leaves the hospital.
While at the hospital, having the patient verbalize dietary needs as well as instructions for monitoring her blood glucose and administering insulin could evaluate her understanding. Interventions after discharge could be measured by HbA1C values taken as well as monitoring for any signs of infection. With appropriate education and interventions, the patient would have her glucose better controlled which should decrease her risk of infection.
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