Nurses have to master many challenges in the course of their work in domiciliary care. E.g., for the situational adjustment of insulin prescriptions, consultation with and a written prescription from the supervising physician is necessary. However, delayed or non-executed therapy adjustment can lead to acute complications and, as a direct consequence, to hospitalization, which also places a heavy burden on the healthcare system. In order to support caregivers and physicians in the management of insulin therapy, the GlucoTab® system, which has already been tested in clinical inpatient use, was adapted for use in domiciliary care.
Care Concept GlucoTab@MobileCare. After therapy initialization by physicians, the Doctor Control Loop provides support in prescribing insulin therapies. The Nursing Control Loop supports nursing staff in adjusting the insulin dose according to the prescribed regimen.
In order to support healthcare professionals in diabetes therapy, the use of a mobile decision support system (GlucoTab@MobileCare) for insulin therapy of elderly people with type 2 diabetes in need of care in the home environment was tested in a cooperation between JOANNEUM RESEARCH - HEALTH, the Medical University of Graz and the University of Graz. The project goals were to support caregivers in insulin therapy and facilitate independent dose adjustments by nurses, to relieve medical staff, to reduce the risk of blood glucose derailments through rapid therapy adjustment, and to reduce the complexity of insulin therapies.
The developed care concept comprises two control loops. While a ‘Doctor Control Loop’ supports physicians in prescribing insulin therapies, a ‘Nursing Control Loop’ continuously assists nursing staff in adjusting the insulin dose. This relieves physicians and strengthens the autonomous activity of nursing.
The prototype, which was developed as a medical device, was used by the domiciliary homecare service of the Austrian Red Cross in a 3-month proof-of-concept study in accordance with the Austrian Medicines Act (AMG) and the Austrian Medical Devices Act (MPG). The legal framework was evaluated and a care concept with GlucoTab® was developed.
The proof-of-concept study showed the following effects:
- Safe and efficient blood glucose control possible:
There was a safe reduction in mean morning blood glucose of 26 mg/dl and a significant reduction in blood glucose variability. - Continuous therapy adjustment necessary:
To facilitate optimal therapies the insulin dosage was adjusted by the algorithms on an average of 9x per quarter per patient. - Continuous system use implements evidence-based therapy:
More than 95% of tasks were documented or performed using the developed system. - High acceptance of system use:
Both nurses and patients found the system to be very useful in diabetes therapy. - Increased sense of safety:
The subjective feeling of safety of the patients was increased by the expected avoidance of medication errors and hospitalizations.