Impact of an interdisciplinary inpatient diabetes education process on patient understanding and adherence

Purpose: Our hospital recently implemented an organized interdisciplinary education process for teaching hospitalized patients about their diabetes. This project was designed to evaluate how well patients understand and adhere to discharge insulin instructions following hospital discharge.

Methods: A convenience sample of 25 adult medical inpatients with diabetes who were discharged to home with a prescription for scheduled insulin were included.   A questionnaire was administered via telephone 24 to 48 hours following hospital discharge to test patients’ knowledge and adherence to discharge insulin instructions.

Results: Median age was 61 (range 38-89) years and 56% of patients were male. Nine (36%) of the 25 patients had diabetes teaching documented in the medical record by any healthcare professional during hospitalization, although 16 (64%) actually recalled being taught by a nurse, pharmacist or dietician.   Overall, 20 (80%) patients correctly stated when they should administer their insulin(s), 19 (76%) knew how to dispose of their used syringes or pen needles, 16 (64%) knew their doses, and 21 (84%) were able to recognize the symptoms of hypoglycemia. There were no statistically significant differences in correctly answered questions between patients with documentation of teaching compared to those without documentation.  Of the patients on multiple insulin products (n = 14), 85.7% could correctly identify the type of insulin (long-acting vs. short-acting insulin).  Of the patients who were new to insulin (n=5), all (100%) had documentation of teaching and four (80%) were taught by a pharmacist.

Conclusion: This QI project shows that insulin education is not documented for most inpatients at our hospital. Although most patients had some knowledge of how to administer their insulin, there were still knowledge deficits, especially with respect to insulin dosing.