Best Practice Guideline for the Subcutaneous ...

1 Best Practice Guideline for the SubcutaneousAdministration of Insulin in AdultswithType 2 DiabetesNursing Best Practice GuidelineShaping the future of NursingJune 2004 Greetings fromDoris Grinspun Executive DirectorRegistered Nurses Association of Ontario It is with great excitement that the Registered Nurses Association of Ontario (RNAO)disseminates this nursing best Practice Guideline to you. Evidence-based Practice supportsthe excellence in service that nurses are committed to deliver in our day-to-day Practice . We offer our endless thanks to the many institutions and individuals that are makingRNAO s vision for Nursing Best Practice guidelines (NBPGs) a reality. The Ontario Ministryof Health and Long-Term Care recognized RNAO s ability to lead this project and is providing multi-yearfunding.

2 Tazim Virani NBPG project director with her fearless determination and skills, is moving the project forward faster and stronger than ever imagined. The nursing community, with its commitment andpassion for excellence in nursing care, is providing the knowledge and countless hours essential to the creationand evaluation of each Guideline . Employers have responded enthusiastically to the request for proposals(RFP), and are opening their organizations to pilot test the NBPGs. Now comes the true test in this phenomenal journey: will nurses utilize the guidelines in their day-to-day Practice ? Successful uptake of these NBPGs requires a concerted effort of four groups: nurses themselves, otherhealthcare colleagues, nurse educators in academic and Practice settings, and employers.

3 After lodgingthese guidelines into their minds and hearts, knowledgeable and skillful nurses and nursing students needhealthy and supportive work environments to help bring these guidelines to life. We ask that you share this NBPG, and others, with members of the interdisciplinary team. There is much tolearn from one another. Together, we can ensure that Ontarians receive the best possible care every time theycome in contact with us. Let s make them the real winners of this important effort!RNAO will continue to work hard at developing and evaluating future guidelines . We wish you the best for a successful implementation!Doris Grinspun, RN, MScN, PhD (candidate)Executive DirectorRegistered Nurses Association of OntarioHow to Use this DocumentThis nursing best Practice Guideline is a comprehensive document providingresources necessary for the support of evidence-based nursing Practice .

4 The documentneeds to be reviewed and applied, based on the specific needs of the organization or Practice setting/environment, as well as the needs and wishes of the client. Guidelinesshould not be applied in a cookbook fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures andsupports are in place to provide the best possible , other healthcare professionals and administrators who are leading and facilitatingpractice changes will find this document valuable for the development of policies, procedures, protocols, educational programs, assessments and documentation tools. It isrecommended that the nursing best Practice guidelines be used as a resource tool.

5 Nursesproviding direct client care will benefit from reviewing the recommendations, the evidencein support of the recommendations and the process that was used to develop the , it is highly recommended that Practice settings/environments adapt these guidelines in formats that would be user-friendly for daily use. This Guideline has some suggested formats for such local adaptation and wishing to use the Guideline may decide to do so in a number of ways: Assess current nursing and healthcare practices using the recommendations in theguideline. Identify recommendations that will address identified needs or gaps in services. Systematically develop a plan to implement the recommendations using associatedtools and is interested in hearing how you have implemented this Guideline .

6 Please contact usto share your story. Implementation resources will be made available through the RNAO website at assist individuals and organizations to implementbest Practice Best Practice Guideline2 Best Practice Guideline for the Subcutaneous Administration of Insulin in Adults with Type 2 DiabetesGuideline Development Panel MembersDeclarations of interest and confidentiality were made by all members of the Guideline development details are available from the Registered Nurses Association of Brundage, RN, BHSc(N), CDETeam LeaderManagerTRIDEC Sunnybrook and Women s College Health Sciences CentreToronto, OntarioCeilia Ayotte, RN, CDED iabetes EducatorPeterborough Regional Health CentrePeterborough, OntarioMarianne Beckstead, RN, MN, CDEC linical Nurse Specialist DiabetesUniversity Health NetworkToronto, OntarioSharon Brez, RN, BScN, MA(Ed)

7 , CDEA dvanced Practice NurseEndocrinology and MetabolismThe Ottawa HospitalOttawa, OntarioLinda Fraser, RN, BScN, CDED iabetes EducatorVictorian Order of Nurses PeelMississauga, OntarioKaren Gorecki, RN, MNClinical Nurse Specialist DiabetesLeadership Sinai Centre for DiabetesMount Sinai HospitalToronto, OntarioRobin Hokstad, RN, CDED iabetes Nurse EducatorDiabetes Centre Nipissing DistrictNorth Bay, OntarioNancy Muller, RN, CDED iabetes Nurse EducatorRed Lake District Diabetes ProgramRed Lake, OntarioMary Beth Neibert, RN, MS, CDE, ACNPC linical Nurse Specialist Diabetes St. Joseph s Hospital Hamilton, OntarioJosephine Santos, RN, MNFacilitator, Project CoordinatorNursing Best Practice guidelines ProjectRegistered Nurses Association of OntarioToronto, OntarioSusan Stinson, RN, CDED iabetes Education Centre Grand River HospitalType 2 Health Management ClinicSt.

8 Mary s HospitalKitchener, OntarioBest Practice Guideline forthe Subcutaneous Administration of Insulin in Adults with Type 2 DiabetesProject team:Tazim Virani,RN, MScNProject DirectorJosephine Santos,RN, MNProject CoordinatorHeather McConnell,RN, BScN, MA(Ed) Project ManagerJane M. Schouten,RN, BScN, MBAP roject CoordinatorStephanie Lappan-Gracon,RN, MNProject Coordinator Best Practice Champions NetworkCarrie ScottProject AssistantMelissa Kennedy,BAProject AssistantElaine Gergolas,BAProject Coordinator Advanced Clinical/PracticeFellowshipsKeith Powell,BA, AITWeb EditorRegistered Nurses Association of OntarioNursing Best Practice guidelines Project111 Richmond Street West, Suite 1100 Toronto, Ontario M5H 2G4 Website: Best Practice Guideline34 Best Practice Guideline for the Subcutaneous Administration of Insulin in Adults with Type 2 DiabetesAcknowledgementStakeholders representing diverse perspectives were solicited for their feedbackand the Registered Nurses Association of Ontario wishes to acknowlege the following for their contribution in reviewing this Nursing Best Practice Baughan, RN, BScN, CDEM anagerDiabetes Education Programs & StrategiesCanadian Diabetes AssociationToronto, OntarioJulie Carthew, RN, MN, ACNP, CDEC linical Nurse Specialist/Nurse PractitionerSt.

9 Michael s HospitalToronto, OntarioBarbara Cleave, RN, BScN, CDED iabetes EducatorMount Sinai HospitalToronto, OntarioSusan Corringham, RN, ENCS taff Nurse, Family PracticeWomen s College Family Practice Health CentreToronto, OntarioMargaret DeMelo, BSc, RD, CDEP rofessional Practice LeaderClinical Dietitian Diabetes EducatorUniversity Health NetworkToronto, OntarioDiabetes Health Thunder BayThunder Bay, OntarioMaggie Bellefountaine, RD, MSA, CDE,ManagerSusan Baca, RNDiabetes Nurse EducatorSharon Jasper, RN, CDED iabetes Nurse EducatorNicola Novak, RN, CDED iabetes Nurse EducatorMarcia Wilmot, RNDiabetes Nurse EducatorMargaret Dorcas, RNSite LeaderBurlington Site of Halton Diabetes ProgramJoseph Brant Memorial HospitalBurlington, OntarioHenry Halapy, RPhPharmacistSt. Michael s HospitalToronto, OntarioDr.

10 Anne Kenshole, MB, BS, FRCPC, FACPP rofessor of MedicineWomen s College HospitalUniversity of TorontoFaculty of MedicineToronto, OntarioSandra Kilroy, RD, CDED ietitian Diabetes EducatorDiabetes Centre Nipissing DistrictNorth Bay, OntarioLynne LaFrance, RN, HBScNDiabetes Nurse EducatorGeraldton Diabetes Education CentreGeraldton, OntarioCarolyn Lawton, RN, MScN, CDEN urse Practitioner, EndocrinologySunnybrook & Women s College HealthSciences CentreToronto, OntarioFreda Leung, BScPhm, CDEC linical PharmacistScarborough Hospital, General DivisionToronto, OntarioDr. Lorraine Lipscombe, MD, FRCPCC linical Associate Endocrinology & MetabolismSunnybrook & Women s College HealthSciences CentreToronto, OntarioDonna Loughren, RN, BScN, CDES taff NurseVictorian Order of Nurses PeelMississauga, OntarioJeanette Macdonald, MA, RSW, CDES ocial WorkerTRIDEC, Sunnybrook & Women s CollegeHealth Science CentreToronto, Ontario5 Nursing Best Practice Guideline6 Best Practice Guideline for the Subcutaneous Administration of Insulin in Adults with Type 2 DiabetesClaudia Mariano, RN(EC), BScN, MScPrimary Health Care Nurse PractitionerEast End Community Health CentreToronto, OntarioGrace Victoria Parucha, RN, BScN,MScN(c), GNC(C)