One out of four people age 65 and older residing in a long term care facility (LTCF) has type 2 diabetes (T2DM). Care and management of this population is a challenge for nurses and other providers. American Diabetes Association Guidelines (2017) recommend application of individualized HbA1c targets for LTCF residents, especially for those with compromises in clinical and functional status.

A needs assessment in a local LTCF identified deficiencies in the provision of evidence-based T2DM care for this LTCF population. This quality improvement (QI) project strove to 1) educate nurses about these residents’ needs and 2) incorporate the use of best practice diabetes standards in the nurse practitioner’s practice by providing in-service education. Specifically, emphasis was placed on HbA1c and finger stick monitoring, eye exams, and foot care.

Results indicated that educational in-services were an effective approach to improving knowledge concerning care of complex TD2M patients. The Advanced Practice Registered Nurse (APRN) (60% to 100%), the 3 registered nurses (63% to 87%) and 9 licensed vocational nurses (63% to 71%) increased in knowledge from baseline to the final 10 question post-test.

However, ophthalmology and podiatry referrals were not ordered routinely because of APRN, staff, and organizational resistance. Per an audit of 22 patient charts, utilization of standardized orders improved routine T2DM care. There were 13 HbA1c due and 12 were ordered (92%); the one renal panel that was due was ordered, and all 5 urine to albumin creatinine ratio were ordered. In addition, the APRN has awareness to evaluate discrepancies between HbA1c results and finger stick values.

QI projects in LTCFs may be difficult to implement and sustain related to staff turnover, understaffing, high patient acuity, and organizational and provider opposition. APRNs must advocate for continual utilization of evidence-based practice guidelines for all LTCF residents.


A.L. Hubberd: None. C.M. Hernandez: None.

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