• diabetes mellitus;
  • capillary blood glucose testing;
  • protocol;
  • rehabilitation;
  • nursing home

OBJECTIVES: To develop an algorithm to standardize capillary blood glucose (CBG) testing in nursing home and rehabilitation patients.

DESIGN: Descriptive study in which an interdisciplinary team from a nursing home, a rehabilitation center, and a diabetes mellitus care program developed and tested a protocol to standardize diabetes management parameters and CBG testing frequency.

SETTING: Department of Veterans Affairs nursing home and rehabilitation unit.

PARTICIPANTS: One hundred one patients admitted to the units during the 6-month study period who had orders for CBG testing.

INTERVENTION: Use of a standardized CBG testing protocol.

MEASUREMENTS: Use of management goal, use of CBG testing protocol, total CBG tests/month.

RESULTS: One hundred one subjects received orders for CBG testing; 72 (72%) received orders for a management goal, and 69 (69%) received orders to use the CBG protocol. Of these 69 patients, 22 met their CBG goals and were advanced to less-frequent CBG testing using the protocol, and 15 did not meet their CBG goals and were not advanced. An additional 15 patients were advanced to less-frequent CBG testing but not using the protocol. In all, 54 of 69 patients (78%) were advanced or could have been advanced by protocol to less-frequent CBG testing. Total CBG testing per month did not change before, during, or after the study period.

CONCLUSION: This protocol would be useful in long-term care facilities and in other congregate living settings where patients with diabetes mellitus have staff assisting with their diabetes management. Barriers to successful implementation are discussed.