Improving Processes of Care for Women with Gestational Diabetes

Objective:The Gestational Diabetes Project at Women and Children's Medicine Center has as its objective to establish a systematic process for the identification and documentation of gestational diabetes; education of women with GDM; and consistent post-partum care, which includes a blood glucose test.  Our aims are to 1. ensure consistent care for woment GDM, 2. identify women that may have type 2 diabetes rather than GDM, and 3. reduce the incidence of new onset Type 2 diabetes.

Methods:A team composed of a physician leader, nurse manager, public health expert, educator and faciltators employ rapid cycle improvement to implement processes of care that meet the aims of the project

Results:All patients are screened between 24 and 28 weeks unless other factors are present that determine an earlier screening. E.g. obesity or a previous macrosomic child. All women receive 1 hour non-fasting blood sugar.  If >140, this triggers a 3 hour glucose tolerance; if 1 hour is > 200, patient is placed on diet therapy. Documentation is on ACOG prenatal form.  Women are referred to diabetes education classes.  Lab comes to clinic for lab draws.  Charts of GDM women are labeled.  A separate data collection form for the project was developed.  An incentive program for post-partum follow up is in place.  Physician and staff adherence is addressed through simplification, bins on the wall for maintaining materials. Discharge orders are changed to automatically document follow-up visits.

Conclusion:  Women are being screened and followed.  Six women have been identified and are enrolled in the post-partum follow up program.