Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário

Detalhes bibliográficos
Autor(a) principal: Carpentieri, Giovanna Braganholo [UNIFESP]
Data de Publicação: 2016
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4907909
http://repositorio.unifesp.br/handle/11600/46632
Resumo: Introduction: Hyperglycemia in diabetic and non-diabetic patients hospitalized in noncritically ill condition is common in general hospitals. Several observational studies with inpatients show a strong correlation between hyperglycemia and increased risk of adverse clinical outcomes, such as prolonged hospitalization, higher infections rates, increased morbidity and mortality and increased hospital costs. Although current guidelines recommend that hyperglycemic patients should be treated with basal-bolus insulin regimen, a more physiological and effective method, in most hospitals it still prevails the use of the sliding scale, treatment associated with increased glycemic variability and poor prognosis. Purpose: Develop and implement an institutional protocol for glycemic control in noncritically ill inpatients. Methods: The study was conducted at Hospital São Paulo of the Paulista School of Medicine - Federal University of São Paulo. The project was developed in three phases. The first phase consisted of the theoretical foundation and development of a pilot protocol according to the current guidelines and based on existing protocols at other institutions. In the second phase, meetings were held with the Clinical and Technical Directors and with the management teams of nutrition, laboratory and nursing to adapt the pilot protocol to the needs and technical and human conditions of the hospital. The last phase was based on an outreach program for the professionals involved in the inpatients care. Results: a protocol for glycemic control for noncritically ill patients customized according to the complexity and the material and human resources of the Hospital São Paulo was prepared. The protocol was designed in the form of flow charts, one for the treatment of hyperglycemia, using the basal-bolus insulin therapy regimen, and a second one for the treatment of hypoglycemia. It was approved by the board of the Hospital São Paulo. The outreach plan included training of professionals involved in the care of hospitalized patients through printed materials, lectures and teaching materials available on the Internet. After training, the project was implemented in 30 medical and surgical wards of the institution. Conclusion: The development and implementation of an institutional protocol for glycemic control is a potentially effective way to increase security by treating hyperglycemic patients and improve the quality of care provided by health professionals. This deployment model can guide other hospitals in their initiatives for the management of blood glucose levels in hospitalized patients.
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spelling Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciáriodiabetes mellitusinsulinhyperglycemiahypoglycemiaprotocoldiabetes mellitusinsulinahiperglicemiahipoglicemiaprotocoloIntroduction: Hyperglycemia in diabetic and non-diabetic patients hospitalized in noncritically ill condition is common in general hospitals. Several observational studies with inpatients show a strong correlation between hyperglycemia and increased risk of adverse clinical outcomes, such as prolonged hospitalization, higher infections rates, increased morbidity and mortality and increased hospital costs. Although current guidelines recommend that hyperglycemic patients should be treated with basal-bolus insulin regimen, a more physiological and effective method, in most hospitals it still prevails the use of the sliding scale, treatment associated with increased glycemic variability and poor prognosis. Purpose: Develop and implement an institutional protocol for glycemic control in noncritically ill inpatients. Methods: The study was conducted at Hospital São Paulo of the Paulista School of Medicine - Federal University of São Paulo. The project was developed in three phases. The first phase consisted of the theoretical foundation and development of a pilot protocol according to the current guidelines and based on existing protocols at other institutions. In the second phase, meetings were held with the Clinical and Technical Directors and with the management teams of nutrition, laboratory and nursing to adapt the pilot protocol to the needs and technical and human conditions of the hospital. The last phase was based on an outreach program for the professionals involved in the inpatients care. Results: a protocol for glycemic control for noncritically ill patients customized according to the complexity and the material and human resources of the Hospital São Paulo was prepared. The protocol was designed in the form of flow charts, one for the treatment of hyperglycemia, using the basal-bolus insulin therapy regimen, and a second one for the treatment of hypoglycemia. It was approved by the board of the Hospital São Paulo. The outreach plan included training of professionals involved in the care of hospitalized patients through printed materials, lectures and teaching materials available on the Internet. After training, the project was implemented in 30 medical and surgical wards of the institution. Conclusion: The development and implementation of an institutional protocol for glycemic control is a potentially effective way to increase security by treating hyperglycemic patients and improve the quality of care provided by health professionals. This deployment model can guide other hospitals in their initiatives for the management of blood glucose levels in hospitalized patients.Introdução: A hiperglicemia em pacientes diabéticos e não diabéticos internados em estado não crítico é comum em hospitais gerais. Vários estudos observacionais em pacientes hospitalizados apontam forte correlação entre hiperglicemia e maior risco de desfechos clínicos desfavoráveis, tais como internações prolongadas, maiores taxas de infecções, aumento da morbimortalidade e aumento de custos hospitalares. Embora as diretrizes atuais recomendem que os pacientes hiperglicêmicos sejam tratados com esquema de insulinização basal-bolus, método este mais fisiológico e eficaz, na grande maioria dos hospitais ainda prevalece o uso de escalas progressivas de insulina de acordo com a glicemia, regime associado com maior variabilidade glicêmica e pior prognóstico. Objetivo: Elaborar e implementar um protocolo institucional para controle glicêmico em pacientes não críticos internados. Métodos: O estudo foi conduzido no Hospital São Paulo da Escola Paulista de Medicina - Universidade Federal de São Paulo. Este projeto foi desenvolvido em três fases. A primeira fase consistiu na fundamentação teórica e elaboração de um protocolo piloto de acordo com as diretrizes atuais e baseado em protocolos já existentes em outras instituições. Na segunda fase foram realizadas reuniões com as Diretorias Clínica e Técnica e equipes de gestão de nutrição, laboratório e enfermagem para adequação do protocolo piloto às necessidades e condições técnicas e humanas do hospital. A última fase fundamentou-se em organizar um programa de divulgação para os profissionais envolvidos no cuidado do paciente hospitalizado. Resultados: Foi elaborado um protocolo para controle glicêmico de pacientes não xii críticos customizado de acordo com a complexidade e com os recursos materiais e humanos do Hospital São Paulo. O protocolo foi desenvolvido na forma de dois fluxogramas, sendo um para o tratamento da hiperglicemia, com o esquema de insulinoterapia basal-bolus, e um segundo para o tratamento da hipoglicemia. Este protocolo foi aprovado pela diretoria do hospital. O plano de divulgação contou com treinamento dos profissionais envolvidos no atendimento dos pacientes internados através de material impresso, aulas expositivas e material didático disponibilizado via internet. Após o treinamento, o projeto foi implementado em 30 enfermarias clínicas e cirúrgicas da instituição. Conclusão: A elaboração e implementação de um protocolo institucional para controle glicêmico consiste em uma forma potencialmente eficiente de aumentar a segurança ao tratar os pacientes hiperglicêmicos e melhorar a qualidade do atendimento prestado pelos profissionais de saúde. Este modelo de implementação poderá guiar outros hospitais nas suas iniciativas para o manejo da glicemia em pacientes internados.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016)Universidade Federal de São Paulo (UNIFESP)Sa, Joao Roberto de Sa [UNIFESP]Universidade Federal de São Paulo (UNIFESP)Carpentieri, Giovanna Braganholo [UNIFESP]2018-07-27T15:50:36Z2018-07-27T15:50:36Z2016-07-27info:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/publishedVersion67 p.application/pdfhttps://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4907909CARPENTIERI, Giovanna Braganholo. Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário. 2016. 67 f. Dissertação (Mestrado Profissional) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2016.2016-0984.pdfhttp://repositorio.unifesp.br/handle/11600/46632porinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-01T07:07:00Zoai:repositorio.unifesp.br/:11600/46632Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-01T07:07Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
title Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
spellingShingle Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
Carpentieri, Giovanna Braganholo [UNIFESP]
diabetes mellitus
insulin
hyperglycemia
hypoglycemia
protocol
diabetes mellitus
insulina
hiperglicemia
hipoglicemia
protocolo
title_short Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
title_full Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
title_fullStr Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
title_full_unstemmed Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
title_sort Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário
author Carpentieri, Giovanna Braganholo [UNIFESP]
author_facet Carpentieri, Giovanna Braganholo [UNIFESP]
author_role author
dc.contributor.none.fl_str_mv Sa, Joao Roberto de Sa [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
dc.contributor.author.fl_str_mv Carpentieri, Giovanna Braganholo [UNIFESP]
dc.subject.por.fl_str_mv diabetes mellitus
insulin
hyperglycemia
hypoglycemia
protocol
diabetes mellitus
insulina
hiperglicemia
hipoglicemia
protocolo
topic diabetes mellitus
insulin
hyperglycemia
hypoglycemia
protocol
diabetes mellitus
insulina
hiperglicemia
hipoglicemia
protocolo
description Introduction: Hyperglycemia in diabetic and non-diabetic patients hospitalized in noncritically ill condition is common in general hospitals. Several observational studies with inpatients show a strong correlation between hyperglycemia and increased risk of adverse clinical outcomes, such as prolonged hospitalization, higher infections rates, increased morbidity and mortality and increased hospital costs. Although current guidelines recommend that hyperglycemic patients should be treated with basal-bolus insulin regimen, a more physiological and effective method, in most hospitals it still prevails the use of the sliding scale, treatment associated with increased glycemic variability and poor prognosis. Purpose: Develop and implement an institutional protocol for glycemic control in noncritically ill inpatients. Methods: The study was conducted at Hospital São Paulo of the Paulista School of Medicine - Federal University of São Paulo. The project was developed in three phases. The first phase consisted of the theoretical foundation and development of a pilot protocol according to the current guidelines and based on existing protocols at other institutions. In the second phase, meetings were held with the Clinical and Technical Directors and with the management teams of nutrition, laboratory and nursing to adapt the pilot protocol to the needs and technical and human conditions of the hospital. The last phase was based on an outreach program for the professionals involved in the inpatients care. Results: a protocol for glycemic control for noncritically ill patients customized according to the complexity and the material and human resources of the Hospital São Paulo was prepared. The protocol was designed in the form of flow charts, one for the treatment of hyperglycemia, using the basal-bolus insulin therapy regimen, and a second one for the treatment of hypoglycemia. It was approved by the board of the Hospital São Paulo. The outreach plan included training of professionals involved in the care of hospitalized patients through printed materials, lectures and teaching materials available on the Internet. After training, the project was implemented in 30 medical and surgical wards of the institution. Conclusion: The development and implementation of an institutional protocol for glycemic control is a potentially effective way to increase security by treating hyperglycemic patients and improve the quality of care provided by health professionals. This deployment model can guide other hospitals in their initiatives for the management of blood glucose levels in hospitalized patients.
publishDate 2016
dc.date.none.fl_str_mv 2016-07-27
2018-07-27T15:50:36Z
2018-07-27T15:50:36Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4907909
CARPENTIERI, Giovanna Braganholo. Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário. 2016. 67 f. Dissertação (Mestrado Profissional) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2016.
2016-0984.pdf
http://repositorio.unifesp.br/handle/11600/46632
url https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4907909
http://repositorio.unifesp.br/handle/11600/46632
identifier_str_mv CARPENTIERI, Giovanna Braganholo. Elaboração e implementação de protocolo de controle glicêmico em pacientes não críticos hospitalizados em hospital terciário. 2016. 67 f. Dissertação (Mestrado Profissional) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2016.
2016-0984.pdf
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 67 p.
application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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