MedStar Health Researchers Adapt Diabetes to Go-Inpatient Program to Implement Diabetes Survival Skills Education Within Nursing Unit Workflow

Diabetes researches from across MedStar Health sought to develop a strategy to enable hospital nursing unit staff to deliver diabetes survival skills education to adults with type 2 diabetes within their usual workflow using an adaptation of the Diabetes to Go (D2Go) program to fill the gap in education delivery on inpatient units.

Diabetes survival skills education (DSSE) focuses on core knowledge and skills necessary for safe, effective, short-term diabetes self-care. Inpatient diabetes survival skills education delivery approaches are needed. “Diabetes to Go-Inpatient: Pragmatic Lessons Learned from Implementation of Technology-Enabled Diabetes Survival Skills Education Within Nursing Unit Workflow in an Urban, Tertiary Care Hospital” was published in The Joint Commission Journal on Quality and Patient Safety. Diabetes to Go is an evidence-based diabetes survival skills education program originally designed for outpatients.

The Practical, Robust Implementation and Sustainability Model (PRISM) was used to help redesign D2Go for delivery and evaluate the feasibility of integrating a high-tech tablet computer-enabled DSSE program for hospital inpatients. The study team conducted interviews and focus groups with stakeholders to identify perceived barriers and facilitators for implementation; redesigned the D2Go program via stakeholder feedback and education and human factors principles; developed implementation design for tablet delivery and patient engagement by unit staff; and completed a prospective cohort implementation feasibility study on three medical/surgical units.

The results identified 596 adults with type 2 diabetes on three medical/surgical units, 415 (69.6%) were program eligible. Of those eligible, 59 (14.2%) received, accessed, and engaged with the platform; and among those, 43 (72.9%) completed the intervention, representing just 10.4% of those eligible. Multilevel implementation barriers were encountered: staff (receptivity, time, production pressures, culture); process (electronic health record [EHR] integration, patient identification, data tracking, bedside delivery); and patient (receptivity, acuity, availability, accessibility).

In conclusion, strategies are needed to enable effective delivery of diabetes survival skills education to inpatients with type 2 diabetes. System and staffing barriers coupled with patient and technology barriers limited successful implementation of the delivery of diabetes education at the bedside. As a result, adoption of a tablet-based diabetes survival skills e-learning program in a high-acuity care setting was limited.

The Joint Commission Journal on Quality and Patient Safety, 2021. DOI: 10.1016/j.jcjq.2020.10.007