Background
Typically, managing diabetic ketoacidosis (DKA) in children is labor intensive and includes collection and monitoring of hourly subcutaneous blood glucose, vital signs, neurological assessment, and other laboratory values every 2 to 4 hours by nurses. Intravenous (IV) hydration is imperative and requires frequent fluid changes based on laboratory results. Managing IV fluids is problematic because of delays in physician return calls, pharmacy response to physician orders, and delivery of IV fluids to patient areas.
Aims
The purpose of this pilot study was to investigate whether a streamlined process using a three-bag system for treating children with DKA would improve efficiency for nurses, length of hospitalization, cost, and blood glucose levels.
Methods
Pediatric hospitalists developed an order set to treat children with DKA using a three-bag system: Bag 1—3/4 normal saline (NSS) with 20 mEq/L potassium chloride (KCL) and 20 mEq/L K-Phosphate. Bag 2—dextrose (D) 10% 3/4 NSS with 20 mEq KCL/L and 20 mEq/L K-Phosphate. If the serum potassium is greater than 6.0 mmol/L, IV bags without potassium supplements would be used until serum potassium is less than 5.5 mmol/L. Bag 3—1 U regular insulin/1 mL NSS (usually 250 mL IV bag). Pharmacy delivers the bags prepared to the physician's specifications to the unit, and nurses manage administration based on the order set with minimal need to contact the physician. A comparative nonexperimental design was used to evaluate the outcomes of children hospitalized with DKA before and after initiation of the three-bag system. Thirty medical records were reviewed with 16 patients not using the three-bag system (control group) and 14 patients using the three-bag system (study group).
Results
Independent samples t test and chi-square were used to determine significance. There was no difference between the groups for change in glucose. Length of stay, number of IV bags, and cost were reduced in the study group; however, this change was not significant. Verbal orders significantly decreased from the control group (68%) to the study group (14%; p < .008).
Conclusions
By using the three-bag system, there is no indication for reduction in number of IV bags, cost, and length of stay; however, the sample size was too small to demonstrate significance. The reduction in verbal orders may create efficiency by saving nursing time and decreasing medication errors.
Clinical Implications
Using a three-bag system within a DKA order set creates a streamlined process that reduces frequency of verbal orders and creates efficiency for nurses. Further study with a larger sample size is warranted to verify additional benefits of using a three-bag system.
Article info
Identification
Copyright
© 2012 Published by Elsevier Inc.
