Annals of Long Term Care

Development of a Protocol for Capillary Blood Glucose Testing in Nursing Home and Rehabilitation Settings
Scott L. Mader, MD, Kathleen A. Fuglee, RN, MN, CNS, CDE, Deanna S. Allen, RN, Lisa R. Werner, RN, BSN, Wendy A. Wanlass, MD, Keith J. Pagel, MD, Kay L. Beliel, Judy A. McEuen, RN, BSN, CDE, Elizabeth A. Stephens, MD, Nancy L. Allison, NP, CDE, Karen A. McWhorter, MN, RN, and Julie E. Vandling, RN, BSN

OBJECTIVES: To develop an algorithm to standardize capillary blood glucose (CBG) testing in nursing home and rehabilitation patients.

DESIGN: Descriptive study in which an interdisciplinary team from a nursing home, a rehabilitation center, and a diabetes mellitus care program developed and tested a protocol to standardize diabetes management parameters and CBG testing frequency.

SETTING: Department of Veterans Affairs nursing home and rehabilitation unit.

PARTICIPANTS: One hundred one patients admitted to the units during the 6-month study period who had orders for CBG testing.

INTERVENTION: Use of a standardized CBG testing protocol.

MEASUREMENTS: Use of management goal, use of CBG testing protocol, total CBG tests/month.

RESULTS: One hundred one subjects received orders for CBG testing; 72 (72%) received orders for a management goal, and 69 (69%) received orders to use the CBG protocol. Of these 69 patients, 22 met their CBG goals and were advanced to less-frequent CBG testing using the protocol, and 15 did not meet their CBG goals and were not advanced. An additional 15 patients were advanced to less-frequent CBG testing but not using the protocol. In all, 54 of 69 patients (78%) were advanced or could have been advanced by protocol to less-frequent CBG testing. Total CBG testing per month did not change before, during, or after the study period.

CONCLUSION: This protocol would be useful in long-term care facilities and in other congregate living settings where patients with diabetes mellitus have staff assisting with their diabetes management. Barriers to successful implementation are discussed. J Am Geriatr Soc 2006;54(7):1114-1118.

Characteristics of Frail Older Adult Drivers
David B. Carr, MD, Kellie L. Flood, MD, Karen Steger-May, MA, Kenneth B. Schechtman, PhD, and Ellen F. Binder, MD

OBJECTIVES: To determine the prevalence of driving in older adults with mild to moderate physical frailty and to compare characteristics of current frail older adult drivers with those of former drivers in the sample.

DESIGN: Retrospective study of frail older adults enrolled in randomized trials of exercise and hormone replacement therapy.

SETTING: Urban, academic medical center.

PARTICIPANTS: One hundred eighty-three sedentary community-dwelling men and women aged 75 and older with mild to moderate physical frailty, as defined by two of the following three criteria: modified Physical Performance Test (PPT) score between 18 and 32, peak oxygen uptake (VO₂) between 10 and 18 mL/kg per minute, and self-report of difficulty or assistance with one activity of daily living (ADL) or two instrumental ADLs. Participants were classified as current or former drivers.

MEASUREMENTS: Demographic characteristics, medical diagnoses, medication use, modified PPT score, and psychometric tests.

RESULTS: The majority (85%) of the participants were drivers.