DIABETES CARE POLICIES AND PRACTICES IN MICHIGAN NURSING-HOMES, 1991

OBJECTIVE - To describe local standards of care for nursing home patie nts with diabetes, to characterize the care that nursing home patients with diabetes receive in Michigan, and to determine if the care provi ded meets local and national standards. RESEARCH DESIGN AND METHODS - In March 1991, a questionnaire was administered and chart reviews were conducted as part of the Medical Review and Nursing Evaluation conduc ted by the Michigan Department of Public Health. The questionnaire was completed by the head nurses at 17 skilled nursing homes to learn abo ut local institutional standards of care. Chart reviews were conducted on a sample of five patients with diabetes from each nursing home to describe the care provided and to compare it with local and national s tandards. RESULTS - Almost all nursing homes had some diabetes care or ders or protocols. Standing orders were most often present to guide nu tritional and nursing care (e.g., diet, blood glucose monitoring, foot care). Standing orders were less often present to guide medical care (e.g., blood glucose parameters to contact physician) and surveillance of complications (e.g., eye exams). In general, the care provided did not meet local or national standards for diabetes care. Care practice s were closer to national standards when registered dietitians (RDs) p articipated in meal planning and written institutional policies existe d. CONCLUSIONS - In this sample of Michigan nursing homes, those with RDs and standing orders provided care more in keeping with guidelines. There is room for improvement in diabetes care practices in nursing h omes. It may be time for diabetes-related organizations to re-examine standards for diabetes care in nursing homes.