Running head: NURSING 1 Evidence-based information on pathophysiological principles and disease management on Diabetic Ketoacidosis Name Institutional Affiliation NURSING 2 Evidence-based information on pathophysiological principles and disease management on Diabetic Ketoacidosis The research paper by Evans, Thompson, Spratt, Lien and Vorderstrasse (2014) advances research and findings on adoption of new protocols for caring of patients with Diabetic Ketoacidosis (DKA) at Duke University Medical Center. DKA occurs from a total lack of insulin in the body leading to dehydration, hyperglycemia and acidosis culminating to severe life threatening effects. This paper will provide a summary of Evans et al (2014) detailing the background on the research, research problem, methods of obtaining the research data and evaluation and finally limitations of the research. It will then go on to highlight the paper’s relevance to the nursing practice and to nursing students. Summary Background on the research Initial treatment of DKA patients occurs in the Emergency Department (ED) before they are moved to the Medical Intensive Care Unit (MICU) if need be. Treatment of DKA primarily targets closure of the Anion Gap (AG) (Evans et al., 2014). The AG is the difference in anion and cation levels in the serum which is the measure of metabolic acidosis. Closing of the AG difference is attained through IV fluid resuscitation, electrolyte disturbance correction and administration of insulin. Patients were usually treated according to usual care which entailed use of the health providers’ knowledge, standard institutional care practices, DKA guidelines and hospital philosophies (Evans et al., 2014). Recent research has however compared these usual care methods to evidence based DKA and uncovered advantages in the latter. Improvements realized NURSING 3 included improved electrolyte correction rates and faster closure of the AG leading to a shorter time taken in administering insulin. Research problem The evidence based research sought to solve the problem of the lack of standardized treatment protocol for DKA. A Quality Improvement (QI) research revealed that 91% of patients did not receive optimal potassium replacement while 60% had suboptimal fluid replacement (Evans et al., 2014). This QI research highlighted the ineffectiveness of usual care. Aim of the research The research purposed to design an evidence based methodology that will promote effective treatment of DKA patients. The research also aimed at standardizing DKA treatment to facilitate smooth intrafaculty transfer. Method analysis Ethical issues streamlined before commencement of the research included making sure that no sensitive information regarding the patients was used. The data collected was also analyzed explicitly by those responsible for the task. It was also crucial to analyze the possibility of any negative effects of the research on the patients. It was concluded that no harm would come to the DKA patients and that it would actually be beneficial to them. Data analysis practices as well as the proposed protocol were also approved by the local institutional review to ensure compliance with patient data protection regulations. The protocol was formulated based on the most recent recommendations by the American Diabetes Association (ADA). The recommendations by ADA were formulated after the review of 79 peer-reviewed articles on the subject (Evans et al., 2014). The protocol was also NURSING 4 standardized by advanced practice registered nurse and carefully vetted by a team which included endocrinologists, physicians in the ED and MICU as well as nurses and pharmacists (Evans et al., 2014). Finally, the protocol algorithm was adjusted to appropriately meet requirements of Duke University Research Center lab range values. Evaluation methods The DKA treatment protocol was put in effect for three months and a retrospective review of the methods occurred after the three months. The research sample group consisted of a historical control group (N = 41) and the current protocol group (N = 37) (Evans et al., 2014). The control group consisted of patients treated before the introduction of the DKB treatment protocol between 2011 and 2012 (Evans et al., 2014). The current protocol group consisted of patients treated after introduction of the treatment protocol from October 2013. Patient characteristics were compared to ensure that they matched with the baseline. Adherence to protocol was the primary outcome measured by the research while the secondary outcomes analyzed included the time taken to close the AG and the time taken to administer electrolyte resuscitation fluids. Probability of incidence of hypoglycemia was also under scrutiny. Limitations The major limitation to the effectiveness of implementation of the DKA treatment protocol was the simultaneous implementation of the new Electronic Medical Record (EMR) (Evans et al., 2014). This scenario necessitated the nurses to learn and adopt both systems a task that proved to be quite a challenge. The fact that the data was also collected during the initial months of the hospital calendar which was also a time to integrate new residents, fellows and nurses lowered efficiency of implementation (Evans et al., 2014). The small sample size was NURSING 5 another factor limiting implementation of the protocol since it minimized the ability to detect statistical differences. Relevance to nursing students The research paper would prove relevant to nursing students with limited experience in the care and treatment of DKA patients. By highlighting a more efficient protocol in undertaking treatment for the patients, the paper is able to play the role of an eye opener to the young students exposing them to more efficient possibilities. The paper concludes by citing the success of the new protocol hence also acting as undeniable prof to the students that evidence based DKB treatment protocol is a solution. NURSING 6 Reference Evans, K. J., Thompson, J., Spratt, S. E., Lien, L. F., & Vorderstrasse, A. (2014). The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study. Advanced emergency nursing journal, 36(2), 189-198. Retrieved from https://journals.lww.com/aenjournal/Abstract/2014/04000/The_Implementation_and_Eva luation_of_an.10.aspx
