GMH

While Amanda was here today, I learned that the rest of you don't have a ridiculous Blood Glucose protocol that triggers a screen of an individual based on their elevated BG/HbA1c in the hospital. I remember thinking the numbers were a bit crazy when I got here, but I just thought the protocol seemed pretty normal- apparently not. We here at GMH see every patient with a HbA1c > 7, any single BG reading >500 (finger-stick non-fasting BG too), and 3 BG readings > 100 (finger-stick non-fasting and/or AM CBCs).
As Amanda pointed out today, this creates a ridiculous amount of work because most individuals in the hospital will have 3 BG readings > 100 at some point in a typical 4 day hospital stay. In fact, if you arbitrarily checked my BG throughout 4 days I guarantee it's >100 often. Additionally, seeing these patients with mildly elevated BG d/t stress, medications, simply being in the hospital doesn't actually advance or improve the patient's status, its just putting your hands in extra pots. Amanda pointed out a very interesting management perspective that visibility does not equal job security - especially in the days of EVIDENCE-BASED practice and EVIDENCE-BASED reimbursement and EVIDENCE-BASED everything. I think she's correct and I also think that if you have/are a manager who tries to extend the RDs into screening individuals who are at low risk, this actually can hinder their appropriate care for the higher risk individuals. I mean, nobody wants more work, but when the extra work is pointless and is also decreasing the level of care provided for patients who need you, it's not good for anyone.
Tomorrow I get to be creative in the morning and work on a handout/brochure for another chef/dietitian demonstration, which is good because I'm really starting to miss the creativity in this job!