Title : Bridging the gap in pediatric inpatient diabetes education: A quality improvement initiative
Abstract:
Background: A multidisciplinary team consisting of pediatric endocrinologists, a clinical nurse specialist and pediatric nurse and dietitian diabetes educators identified gaps in diabetes education among inpatient nurses, including insulin calculation, carbohydrate counting, and understanding insulin use. Knowledge deficits led to errors in patient care. Addressing these knowledge gaps became a patient safety priority.
Local Problem: Nurses were unaware of the education patients and families received from the diabetes education team, leading to inconsistent diabetes management. Additionally, there was no standardized hospital-wide diabetes training. Nurse leaders did not consider diabetes training mandatory, and efforts to address these gaps were hindered by low attendance.
Methods: A quality improvement (QI) initiative was launched using a structured quarterly plan. The initiative began with a pre-assessment survey to evaluate nurses’ baseline diabetes knowledge. Education was delivered through online learning modules, in-person training, and resource distribution. To encourage participation, nurses were provided with reminders and various flexible scheduling options. A post-training survey was conducted to measure improvements in knowledge and confidence.
Intervention: The intervention included:
- Pre-Assessment – To assess baseline knowledge.
- Online Learning – A learning module launched in December 2024.
- In-Person & Virtual Training – Live classes were held to reinforce key concepts, including insulin calculations and administration, glucose management, and emergency care.
- Resource Development – Nursing Badge Buddies and resource binders.
- Superuser Program – Experienced nurses were trained as “superusers” to provide ongoing peer support and education that came to the in-person sessions.
Results: The initial knowledge assessment was completed by 70 nurses, revealing significant gaps, with >50% of participants providing incorrect responses in several questions. The online module had a completion rate of 57% after two months. Participation in live or virtual training sessions was low, with only 19 nurses participating despite efforts to improve attendance. Post test scores showed improvement (Figure 1). There remain continued challenges in inpatient diabetes management related to nursing care such as mismanaging hypoglycemia cases.
Conclusion: The QI initiative demonstrated the need for structured diabetes education for inpatient nurses. Although improvements were made, participation was low. Future efforts will focus on reinforcing education through superusers, leadership engagement, and continuous competency evaluations. The initiative’s long-term goal is to integrate diabetes training as a mandatory hospital-wide requirement.
