Date of Conferral

10-30-2024

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Cara Krulewitch

Abstract

Summary A clinical practice guideline (CPG) was developed because the perinatal department lacked standardized management of pregestational and gestational diabetes. The practice issue is relevant since managing maternal glucose ranges during pregnancy mitigates adverse maternal and neonatal outcomes. The practice-focused question asks, “What are the best practices to manage diabetes in the intrapartum and postpartum settings?” The project was designed to develop an evidence-based protocol to provide standardized management for nurses and providers. Most studies in the literature search were quantitative sources with either A or B overall quality ratings. Based on the evidence, the intrapartum target maternal glucose range should be within 70–125 mg/dL. Additionally, patients with gestational diabetes should have glucose assessments every 4 hours and treatment if levels exceed parameters, patients with pre-existing diabetes should have glucose assessments every hour during labor or induction, and patients with pregestational or gestational diabetes who require insulin or insulin reduction postpartum should receive lactation support. Safety guidance and contraindications for insulin pumps and continuous glucose monitors were also discussed. An expert panel (N = 3) mean rating of the quality of the CPG was 6 (on a Likert scale from 1 to 7) using the AGREE II instrument and recommended the guideline with modifications. Reviewers noted a lack of patient and family involvement, a lack of consent, and a need to define euglycemia and hyperglycemia. A CPG will facilitate improved workflows, enhance nursing and provider autonomy, and mitigate adverse outcomes while promoting patient needs, supporting diversity, equity, and inclusion.

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