Insulin Pump Policy for the Hospitalized Patient


Insulin pump safety has become an urgent and significant concern for the hospitalized patient and staff. Hospitals have policy and procedures on patient’s storage and self-administration of home medications. However, these policies do not address insulin delivered by an insulin pump ("Insulin Pump Safety," September 18, 2012). An insulin pump delivers rapid action insulin hourly by a set basal rate and the patient delivers their boluses according to their blood sugar and carbohydrate intake. Boluses are calculated with settings such as insulin to carbohydrate ratio, insulin sensitivity ratio, a blood glucose target, and active insulin time for covering their meals and/or correcting hyperglycemia. These pump settings are determined by their doctor, usually an Endocrinologist.

Policy development related to insulin pumps is focused on the lack of knowledge by the nursing staff. The lack of adequate policies for patients admitted to the hospital with insulin pumps has resulted in detrimental cases of hypoglycemia and even death. Recently, a local hospital reported a patient whom was admitted through the emergency room needing and emergency surgery. This gentleman was wearing an insulin pump that somehow went unnoticed or was assumed to be turned off. The patient went through three departments: emergency room, surgery, and recovery. He became hypoglycemic with glucose of 20mg/dl because his insulin pump was delivering insulin and the nursing staff was also administering insulin intravenously. It wasn’t until his hypoglycemic attack and family communication to staff about his insulin pump that they realized how this had happened. It would be more comforting to assume that this was a rarity, but research shows what was expected. This local episode was not a rarity and insulin pump patients admitted into the hospital are in real danger.


Population needs

Inadvertent hypoglycemia is can be related to the lack of policy and procedure for the management of the hospitalized patient wearing an insulin pump. Unless facilities establish a plan with policies and procedures to guide the safe management of patients on pumps, errors will occur with some being fatal (Cook, 2009). Investigations with other local nurse educators in the hospital setting, it was alarming to know there are no policies for the patients admitted wearing an insulin pump. There are protocols to follow when the diabetes department is consulted, but nothing for the general nursing staff to initiate and/or follow.


The objective of the policy is for the patient and their family to be offered safe quality care, monitoring, and accurate insulin administration. The policy focuses on promoting patient independence in managing their diabetes by wearing their insulin pump. The needs of the patient are safe monitored administration of insulin without hypoglycemic events leading to adverse effects. Diabetic education and use of medical devices for delivery are critical education issues provided by nurses. Polices and protocols are essential tools in the education process. This can be achieved by having the patient review and sign an agreement to follow hospital protocol on insulin pumps. This agreement should include specific actions for all parties involved, nurse, patient, and care-giver. The patient should understand the importance of reporting site changes, boluses, or any pump problems. Both parties agree to communicate daily and at any time, if the patient is unable or unwilling to comply, the insulin pump will be removed.

Process and procedures

Research to identify evidence-based practices is critical in providing excellence in patient care. Open discussions with the nursing staff and nurse educators provide the essential background data in establishing current practices and understanding. Soliciting input from interdisciplinary teams promotes a team effort in addressing the issues and providing safe care. Assess patient/family’s willingness, cognitive status, and orientation to self-manage insulin pump. Nursing managers and administrators have the final authority for approval along with the Medical Review Board of the organization.


Policies with protocols are needed to protect the safety and quality of care of these unique patients. The first step to achieve this goal is to submit a policy to the hospital’s policy and procedure committee for review and approval. Once approved it should be implemented throughout the hospital where all staff can be guided to give safe quality care and administration of insulin via insulin pump. Not only does this allow these patients independence in self-management, but most importantly will reduce and/or prevent adverse events. Based on the organizational policy, new policies and procedures should be evaluated upon implementation and periodically, usually annually, for possible revisions.


Organizational response to patient safety needs is the responsibility of all members of the health care team. This responsibility flows from upper administration, through all levels of the organization. Policies and procedures are the guiding tools to provide safety, effective, and efficient patient care. The nursing process provides well-established means to address policy needs within the organization. Assessing the need, identifying the focus, planning the implementation, implementing the plan, and evaluating the results yields greater patient safety. Implementing a policy to meet the needs of Diabetic patients on insulin pumps is an example of patient-centered care and safety.

Evidence Based Practice Research Paper


Obesity is a condition that is characterized by excess body fat. Obesity has significant health effects on both mortality and chronic disease and has raised concern worldwide. The Surgeon General’s “Call for Effort to Prevent and Decrease Overweight and Obesity” in the setting of increasing prevalence, highlights the significance of obesity as a public healthcare problem in the United States. According to the World Health Organization (WHO), it is estimated that there will be 2.1 billion overweight people aged 14 years and above and 900 million obese people in 2018. The cases of obesity are steadily increasing in many parts of the world although a few developed countries, for example, Germany and the United Kingdom have experienced a decrease in the prevalence of obesity in the past decade. Literature research has shown that obesity and overweight are the primary causes of co-morbidities such as cardiovascular disorders, several cancers type II diabetes, and can lead to mortality and morbidity. The cost of health care required to control these complications is substantial (Johnson, Dohrmann, Burt, & Mohadjer, 2014, p, 162).

For example, in the U.S, the total cost needed to treat complications associated with obesity accounts for 1.5% gross domestic product. The Canada, the total direct cost attributable to obesity and overweight is estimated to be 5.5 US dollars, and this figure corresponded to 4.7% of the total expenditure in 2014. In Europe, about 12 billion Euros was used up on overweight, and obesity-related complications in 2014 and relative economic burden ranged from 0.08 to 0.51 of, the national gross domestic product. In China, the cost attributed to obesity-related complications in 2014 was about 2.75 billion US dollars, and these corresponded to 4.1% of the total national medicine costs. Besides, the direct cost has always been shown to increase if related co-morbidities are included (Johnson, Dohrmann, Burt, & Mohadjer, 2014, p, 162). Obesity is usually measured by body mass index (BMI) which is a measure of weight adjusted for height. Body mass index is calculated by dividing kilograms of the weight of an individual by meters of their height squared. However, there are various techniques used to evaluate body fat, the parameters for BMI are easy to measure. Research has shown a big correlation in BMI and body fat in children and adults. Individuals with a BMI of 25 to 29 are identified as overweight, while those with a BMI of above 30 are identified as obese. These limits are grounded on epidemiologic evidence of discernable, then considerable increase in deaths related to obesity cases.


Significance of Overweight and Obesity

Obesity is a risk for many causes of death including diabetes, some cancers, and cardiovascular diseases. Obesity has been associated with many causes of illnesses such as gall bladder disease, osteoarthritis, respiratory impairment and sleep apnea. Conversely, overweight is a risk factor for various cancers including gall bladder cancer, colon cancer, breast cancer, prostate cancer, biliary tract cancer, cancer of the cervix, ovarian cancer, endometrial cancer, and rectal cancer. Overweight is related to concerns of a quality life such as social stigmatization and reduced mobility (Johnson, Dohrmann, Burt, & Mohadjer, 2014, p, 164). The danger associated with specific illnesses tends to increase proportionally with increased BMI than the risk related to the total mortality. Most often, this trend has been demonstrated for cardiovascular diseases. For instance, in a study carried out for a British cohort men the prevalence of major coronary cases was 8.1 per 1,000 individual years for those with a BMI range of 24 to 29. Conversely, coronary heart disease incidence in participants from Framingham was 19 per 1,000 years for men with a BMI range of 23 to 25. In all these cohorts, the susceptibility of developing cardiovascular complication has been seen to increase with the rising range of BMI for men. Similarly, the increase in cardiovascular is seen with the proportional increase of BMI in group studies for women.

Research Evidence Sources

The cases of obesity among U.S adults during 2011-2014 were estimated to be 36.5% (NCSHS, 2015). However, this figure indicated a view about the condition. The prevalence of obesity among adults aged 60 and above (37.0%) and middle-aged adults aged 40-59 was higher than young adults aged 20-39. Another research involved randomized clinical trials (RTC) that included the outcomes of change in BMI. The study compared laparoscopic banding techniques laparoscopic versus open banding techniques in the studies of the effectiveness of surgical intervention for weight loss (NCSHS, 2015).

Wit et al. (2014, p 64) study used 50 obese patients who had a BMI value of over 40. The patients were randomized to either laparoscopic or open adjustable silicone gastric banding. Each of the two groups showed significant average weight drop over one year: 34 kg in the open surgical group and 35 kg in the laparoscopic group. Accordingly, there was a decline BMI in for the open group from 47.9 to 39.3 while in the laparoscopic group there was a drop from 51.4 to 39.5. Complications in the randomized clinical trials included an umbilical hernia (3%), incisional hernias (13.4%) and infection

Non-Research Evidence Sources

The research utilized cohort studies as a non-research evidence source for obesity surgery. Although randomized clinical trials are the preferred form of evidence, this was a situation in which carefully evaluated cohort data were are appropriate. The Swedish Obese Subjects (SOS) research study was employed as the non-research evidence source during the study. The SOS study involved nonrandomized matched controls in which 700 primary health care facilities and 36 universities and county in Sweden. The invasive arm is equally among three surgical methods: gastric bypass, gastric banding and vertical banded gastroplasty (Golubic et al., 2013, p, 405). The controls were treated with non-surgical options available. The data revealed after a duration of two years indicated a drop of 0.5 among the control and 27 kg (23%) among the surgical patients. The percentage drop in weight after vertical banded gastroplasty, gastric banding, and gastric bypass were 23%, 21%, and 32% respectively. Another non-research evidence source which involved 251 patients control patients and 234 patients in the surgical group. The three-year follow-up of data indicated a 20 kg drop in weight among the surgical patient and 0.8 % weight loss in control (James, & Theodore, 2012).


From this review, it is evident that obesity and overweight are a\ common complications that pose a substantial burden to a country. Obese patients can receive modest but clinically weight loss through a range of measures. For instance physical exercise and diet as well as behavioral interventions to modify skills, motivations, and supports associated with physical or dietary patterns. Patients with extreme body mass can be recommended for surgical options. These findings were reached through a variety of source evidence. Randomized clinical trials showed that pharmacotherapy, counseling, can also be used in interventions for obesity and overweight.

Mental Health


There have been calls to action by the National Research Council in collaboration with the Institute of Medicine to make the youth’s health mental, emotional, and behavioral development a priority for the nation (Buki & Piedra, 2011). Various health organizations and metal service administration unit of the government have embarked on developing the national health policies to ensure prevention of mental illnesses. The Hispanic/Latino community is made up of European, African, and Native American descendents (Metrosa, 2006). Hispanics are more socially progressive than non-Hispanics. For Hispanics, family is the most critical social unit and it overshadows the individual or the group. This implies that family is their most critical relationship and as per the 2002 Pew overview, 89% of Hispanics believed that relatives are more imperative than their friends (Kosoko-Lasaki, Cook, & O'Brien, 2009). Relatives are required to help one another in facing life challenges, and to give support if there should be an occurrence of health or money related issues. The family gets together frequently, particularly amid family festivals, for example during birthdays, funerals, or weddings (Buki & Piedra, 2011). Hispanic social health issues and needs are distinctive from those of the general population. Most scientists concur there is a high rate of medicinal services incongruities between the Hispanics and non-Hispanic Whites (Metrosa, 2006). The Hispanoc/Lationo community’s poor health status of racial and ethnic minority Americans is reflected in various aspects of the health delivery systems. For instance, cases of mental health are established to be on the higher side for Latino sub-groups. One study found that Puerto Ricans had the most elevated general mental challenges and stress rates among the Latino ethnic gatherings evaluated (American Psychopathological Association & American Psychopathological Association, 2011).

There is evidence that Latinos in the United States are more prone to postpone required nurture incessant conditions than other ethnic gatherings and are likewise more prone to depend on essential consideration suppliers and less inclined to look for consideration from a psychological well-being pro contrasted with non-Hispanic whites. Lower psychological well-being administration utilization has been connected with larger amounts of Latino ethnic character and Spanish dialect (Metrosa, 2006). Latinos were more outlandish than non-Hispanic whites to have entered the human services for any kind of consideration and to have utilized preventive health awareness. A few past explorations on Latino Americans have likewise tended to Latina-particular data. Higher asthma predominance was accounted for in certain Latino American women compared to their non-Latino counterparts in other ethnic gatherings in the United States.


Health disparities for this group

About 27% of the deaths among Hispanic are attributed to diseases of the heart and stroke. Mexican-Americans are more prone to have hypertension than the general Hispanic population, while the recent are less inclined to have hypertension than non-Hispanic Whites. Mexican-American men are more prone to have high cholesterol levels in the body. Health promotion for this minority group means having a stable body condition but despite this belief, the Latinos have a tendency to rate their health as poor. They are more probable than non-Hispanic whites to have hypertension. Diabetes, which affects people alongside corpulence, is viewed as a persistent among Latinos. Research has also indicated that the behavioral emotional well-being and dangers of the Hispanic population in the United States, have been connected with social challenges like poverty according to Metrosa, E. V. (2006).

Studies have demonstrated that more Hispanic grown-ups and Hispanic youth are particularly helpless against the challenges of migration and cultural assimilation. More Latino youth have pervasive emotions of bitterness and sadness than whites (36% versus 26%) and more endeavour suicide (10% versus 6% of whites). Hispanic youth are more improbable than non-Hispanic youth to consume alcohol and engage in drug abuse. Disposition about dysfunctional behavior and emotional well-being administrations can influence the utilization of administrations. For instance, among a few Latinos, melancholy may be mixed up for anxiety, tiredness or a physical disease, and may be seen as something interim.


Clinically, providers of health services may give careful consideration to create weight control programs for all the Latina subgroups. More ethnic groups focused evaluation and treatment may help such subgroups like the Puerto Rican American women to adapt to asthma and cerebral pains and Mexican American women to help lessen their danger of diabetes. The counteractive action of the previous may have more to do with anxiety management conditions among this group, while aversion of the recent may need to do with way of life and eating diet alterations (LaVeist, 2013). At long last, the need to instruct doctors and other health experts on the sex-particular and ethnic-particular information about this perpetually developing population can't be exaggerated as a result of the expanding part of Latinas in the U.S. workforce and the groups. Build familiarity with emotional wellness and endless ailment association.

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