2025 Southeastern Residency Conference

Title: Evaluating the Implementation of a Standardized Process for Nursing-Led Continuous Glucose Monitoring Patient Education for Home-Based Primary Care
 
Authors: Madison Wilson, Courtney Hines, Brittany Melville
 
Objective: Evaluate the change in nursing confidence following implementation of a standardized process for CGM education for HBPC patients
 
Self-Assessment Question: True or False? There was an increase in nursing confidence following implementation of a standardized process for initial CGM patient/caregiver education for patients in HBPC
 
Background: Continuous glucose monitoring (CGM) devices are essential tools in diabetes management. Education is critical for effective CGM use and monitoring. At the Salisbury Veterans Affairs Health Care System (SVAHCS), CGM education for Home Based Primary Care (HBPC) patients is often completed by HBPC nurses, but there is no current standardized process to guide consistent and effective CGM instruction and monitoring. This quality improvement project aims to implement a standardized process for nursing to deliver CGM education and monitoring in the home and evaluate the change in nursing confidence and documentation following this.

Methods: This quality improvement project will provide HBPC nurses education on a standardized process for CGM education, device setup, interpretation and collection of glucose data, and troubleshooting. SVAHCS HBPC patients who meet criteria for CGM implementation or those already using one, along with HBPC RNs who attend training on the standardized process for CGM education and monitoring will be included. Data collection will be completed from August 1st, 2024 and June 30th, 2025 and will include results of pre- and post-survey questionnaires, nurse documentation of initial CGM education, CGM reader results, and alert via note co-signature to Clinical Pharmacist Practitioner (CPP). The primary objective is to evaluate the change in nursing confidence following implementation of a standardized process for CGM education for HBPC patients. Secondary objectives include evaluating initial and follow-up CGM education documentation, monitoring, and CPP alerts. Descriptive statistics will be used to assess outcomes.

Results: For the primary objective, 10 RNs completed the pre-survey and 8 completed the post-survey. There was a mean increase between 0.8-2.1 in RN confidence for all 5 standardized questions. For documentation of initial CGM education, there were 2 patients with CGM education prior to RN training, 1 of which was documented and the other not being documented. Following education, there were 2 new readers started with a 100% documentation rate. There was a 14% increase in documentation of CGM reader results following education. There was a 21% increase in documentation of average BG for the past 7 days, 19% increase for the past 14 days and 39% increase for the past 30 days. For documentation of average BG based on time of day, 0% had documented this prior to the education and 25% following education. Documentation for time in target, low glucose events, sensor usage, and alert via co-signature to CPP increased post-education between 5%-44%, with sensor usage and alert of note via co-signature to CPP showing the largest increase in documentation following education.

Conclusion: Nursing confidence increased for all survey questions following implementation of a standardized process for initial CGM patient/caregiver education for patients in HBPC and RNs utilized template for CGM initial education documentation. Additionally, documentation of CGM reader results in all data points showing an increase following education. Surprisingly, there was an overall low documentation rate for low glucose events. Education session provided was effective in increasing nursing confidence for initial CGM patient/caregiver education for patients in HBPC and educational intervention increased the documentation of CGM reader results by HBPC RNs.