Developing the hypoglycemia-nursing early warning score system (Hy-NEWSS): A pilot study
Background: Severe hypoglycemia occurs in 6% of type 2 DM patients with a 6 to 7% mortality rate. Amidst the COVID-19 pandemic, there has been a higher rate of fatality among diabetes patients, at least 22% of COVID-19 deaths in Wuhan, China. Furthermore, the condition impairs physiological defense against recurrent hypoglycemia in the future. Accordingly, the innovation in this study aims to prevent severe hypoglycemia among type 2 patients through early risk screening, the use of preventative protocols, and patient and family empowerment. This intervention bundle is called Hypoglycemia-Nursing Early Warning Score System (Hy-NEWSS).
Design and Methods: The innovation was implemented in inpatient and outpatient settings, within two weeks with the following sequence: i) internal training, ii) Hy-NEWSS implementation, iii) outcomes evaluation.
Results: Of the twenty-eight patients involved in the study, 3 patients (19%) had a high risk of hypoglycemia, while the remaining had a low risk for the condition. However, at the end of the study there was no event of severe hypoglycemia (0%), and only 1 event (6.33%) of mild hypoglycemia. The results also showed that the accuracy of nurses in implementing the protocols was 93% and that during the evaluation, 95.62% of the responses of the nurses from the inpatient and outpatient settings were positive. Finally, the scores of the sensitivity and specificity evaluation were 99% and 88%, respectively.
Conclusion: It may be concluded from this initial study that Hy-NEWSS is effective in preventing severe hypoglycemia, accurate in identifying patient risk level for the condition, and has high applicability to be implemented in hospital settings.
Edridge CL, Dunkley AJ, Bodicoat DH, et al. Prevalence and incidence of hypoglycaemia in 532, 542 people with type 2 diabetes on oral therapies and insulin: A systematic review and meta-analysis of population based studies. PLoS One 2015;10:e0126427. DOI: https://doi.org/10.1371/journal.pone.0126427
Fauci S, Kasper D, Hauser S, et al. Harrison’s principles of internal medicine. 19th ed. Michigan: McGraw-Hill Education; 2014.
Clayton D, Woo V, Yale JF. Hypoglycemia. Can J Diabetes 2013;37:S69–71. DOI: https://doi.org/10.1016/j.jcjd.2013.01.022
Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract 2020;162:.108142. DOI: https://doi.org/10.1016/j.diabres.2020.108142
Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271–81. DOI: https://doi.org/10.1016/j.diabres.2018.02.023
Olveira G, Abuín J, López R, et al. Risk factors for hypoglycemia in inpatients with total parenteral nutrition and type 2 diabetes: A post hoc analysis of the InSUPAR study. Endocr Pract 2020;26:604–11. DOI: https://doi.org/10.4158/EP-2019-0482
Angelidi AM, Belanger MJ, Mantzoros CS. COVID-19 and diabetes mellitus: What we know, how our patients should be treated now, and what should happen next. Metabolism 2020;107:154245. DOI: https://doi.org/10.1016/j.metabol.2020.154245
Karter AJ, Warton EM, Lipska KJ, et al. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med 2017;177:1461–70. DOI: https://doi.org/10.1001/jamainternmed.2017.3844
Han K, Yun JS, Park YM, et al. Development and validation of a risk prediction model for severe hypoglycemia in adult patients with type 2 diabetes: A nationwide population-based cohort study. Clin Epidemiol 2018;10:1545–59. DOI: https://doi.org/10.2147/CLEP.S169835
American Diabetes Association [Internet]. Hypoglycemia (low blood glucose). American Diabetes Association. 2020 [cited 2020 Oct 1]. Available from: https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia
Rudianto AD. [Konsensus Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 di Indonesia 2015].[Book in Indonesian]. Jakarta: Indonesian Society of Endocrinology; 2015.
Seaquist ER, Anderson J, Childs B, et al. Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care 2013;36:1384–95. DOI: https://doi.org/10.2337/dc12-2480
Riddle M. Updates to the standards of medical care in diabetes-2018. Diabetes Care 2018;41:2045–7. DOI: https://doi.org/10.2337/dc18-su09
Evert AB. Treatment of mild hypoglycemia. Diabetes Spectr 2014;27:58–62. DOI: https://doi.org/10.2337/diaspect.27.1.58
International Diabetes Federation. Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2012.
Wibisono AH, Lestari AN, Sorensen L, et al. Fear of injections among people with type 2 diabetes: Overview of the problem. J Diabetes Nurs 2017;21:91–5.
Coyle ME, Francis K, Chapman Y. Self-management activities in diabetes care: A systematic review. Aust Heal Rev 2013;37:513–22. DOI: https://doi.org/10.1071/AH13060
Royal Australian College of General Practitioner. Chronic condition self-management guidelines summary for nurses and allied health professionals. Sydney: Royal Australian College of General Practitioner; 2015.
LaManna J, Litchman ML, Dickinson JK, et al. Diabetes education impact on hypoglycemia outcomes: A systematic review of evidence and gaps in the literature. Diabetes Educ 2019;45:349–69. DOI: https://doi.org/10.1177/0145721719855931
Kavuran E, Yurttas A. Effects of education based on Roy adaptation model on diabetes care profile of patients with type 2 diabetes. Iran Red Crescent Med J 2018;20:e64635. DOI: https://doi.org/10.5812/ircmj.64635
Herdman T, Kamitsuru S. Nursing diagnoses definitions and classification 2018–2020. 11th ed. New York: Thieme Publishers; 2018. DOI: https://doi.org/10.1055/b-006-161179
Bulechek G, Butcher H, Dochterman J, et al. Nursing interventions classification. 6th ed. St. Louis: Elsevier Mosby; 2013.
Aligood M. Nursing theorists and their work. Maryland Heights: Elsevier Mosby; 2014.
Roy S, Andrews H. The Roy adaptation model. Norwalk: Appleton & Lange; 2009. DOI: https://doi.org/10.1177/0894318409338692
International Diabetes Federation. Global diabetes plan 2011-2021. Brussels: International Diabetes Federation; 2011.
- Abstract views: 822
- PDF: 149
Copyright (c) 2021 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.