Identifying factors contributing to high readmission of diabetic patients

Identifying factors contributing to heights readmission of diabetic affected role ofsINTRODUCTION.Diabetes Mellitus (DM) is a chronic indisposition. Where the melodic line circulation contain of high scar level, it mess occurs when the pancreas does non produce enough insulin, or when the body can non effectively routine the insulin it produces (WHO).Diabetes is a progressive disease that can lead to a familyificant form of wellness complications and pro formly reduce quality of life. eyepatch m both diabetic tolerants man long time the wellness complication with diet and model and require musics to improve un turn backled gillyflower glucose level.Diabetes has been trea confuse since insulin became available in 1921, and target 2 diabetes may be controlled with medical checkup specialtys. Preeti (2008). Both type 1 and 2 ar chronic insures that usu on the wholey cannot be cured. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyp er osmolar coma. Serious long-term complications include cardiovascular disease, chronic nephritic failure and retinal damage. Adequate treatment of diabetes is important, to control argument pressure level and salubrious lifestyle such as smoking cessation and maintaining a body weight. intercession of diabetes involves diet, exercise, teaching, and medicines. If people with diabetes strictly control blood excoriation levels, complications ar less potential to develop. The goal of diabetes treatment, therefore, is to keep blood dulcorate levels within the normal range as such(prenominal) as possible. Treatment of high blood pressure and cholesterol levels can block virtually of the complications of diabetes as well.A good health grooming from the medical round in the hold can give a good check out to enduring health and prevent forbearing from admit again to the ward. The health education in the ward should begin from day 1 diligent admit to the ward until the tolerant of enter from the ward. This health education should not stop when the patient of is discharge from the ward but it must be go on from the health community to make sure that the patient is healthy. riddle STATEMENT.General ObjectiveTo identify factors contributing to high readmission of diabetic patients gage discharge.1.2.3 Specific objective.To identify why the patient is not deport their medication by and by discharge from the ward.To pick up relationship between hunchledge and medication to the patient.In Malaysia, the Third National wellness and unwholesomeness Survey showed that the preponderance of type 2 Diabetes Mellitus (DM) for adults aged 30years and above was found to be 14.9% in 2006. Salwa et. al., ( 2010).Patients with diabetes should know that how importance their health later on they has confirm progress to diabetes. wellness education to patients and families were given continuously by the nurses when these patients were admitted for stabi lisation of their DM, from day 1 of admission and continued until they carry through with(predicate) with(predicate). With proper health education, the patient should be able to take commission for them self until follow up in the clinic.The health education must include dietary usance and medication. The talk is given by the nutritionist and medication by clinical pharmacist. Nurses should take part in the dietary and medication talk when the patient attends the talk to ensure the compliance by the patient continuously after(prenominal) they discharge from the ward.In January 2011, there are 4 patient has been readmitted to the manlike and female medical ward within 2 weeks after discharge from the ward. To prevent from this admission, health education should be given continuously to the patients both in the ward or by the community health armorial bearing provider when the patient is discharge from the infirmary.CHAPTER 22.1 LITERATURE REVIEW.The literature freshen has been searched from internet.Diabetes mellitus is now a major global public health problem. The relative incidence and prevalence of diabetes are escalating eespecially developing and newly industrialized nations. In Malaysia, diabetes is a growing c erstwhilern. Through the Ministry of Healths six year thematic thinking(a) Lifestyle Campaign which began in 1991, diabetes mellitus was the theme for the year 1995. Here, the promotion of adopting healthy lifestyle practices relating to the prevention of diabetes namely creating knowingness and balance diet, maintain specimen body weight and physical activities were encouraged. The campaign emphasized on creating, awareness of the disease and its complications to the public. Rugayah ( 2007)According to Zook et.al (1980). Hospitalizations account for about one-half of all health grapple expenses, and it has been estimated that 20% of the inpatients in Malaysia and 13% in the USA use more than half of all hospital resources through r epeated admissions. During ultimo decades, hospital readmissions arrest been the subject of retrospective come afters and prospective trials with a notion to their prevention. The objective is to review these studies and focus on the frequency of readmissions of diabetes mellitus patient, their causes and validity as a measure of quality of carry off, and the attempts for their prevention.The recent literature on hospital readmissions and found that most of them are believed to be ca apply by patient frailness and progression of chronic disease. However, from 11% to 52% of all readmissions control been judged to be preventable because they were associated with indicators of substandard care during the hospital care, such as poor resolution of the main problem, unstable therapy at discharge, and inadequate post discharge care and advice. Furthermore, randomized prospective trials hold in shown that 15% to 85% of all readmissions can be prevented by patient education, pre dis charge assessment, and domiciliary aftercare. However, high readmission rate of patients with diabetes mellitus may identify quality-of-care problems. A focus on the specific needfully of such patients may lead to the creation of more responsive health care systems for the chronically ill.Most complications are the resolve of problems with blood vessels. uplifted sugar levels all over a long time cause narrow of both the small and large blood vessels. The narrowing reduces blood menses to many parts of the body, leading to problems. there are several causes of blood vessel narrowing. Complex sugar-based substances build up in the walls of small blood vessels, causing them to thicken and leak. Poor control of blood sugar levels as well as tends to cause the levels of fatty substances in the blood to rise, resulting in atherosclerosis.Poor circulation to the jumble can lead to ulcers and infections and causes wounds to heal slowly. People with diabetes are particularly possi ble to stimulate ulcers and infections of the feet and legs. Too often, these wounds heal slowly or not at all, and amputation of the foot or part of the leg may be needed. shortly there are at least 4-5 patients go away be readmission for stabilization then discharged. Upon admission of a patient, this would cause overpopulation of ward, increase expenses and uncontrolled condition of the patient in the ward. Nurse also must provide health education to the patients, their relative and refer patients to nutritionist and education unit for counseled. mug (2000) conducted a scientific investigate on factor for diabetes patient on knowledge and the diabetic drugs for diabetic patients. The major goal of the research are to identify the important factors for patient compliance in the usage of diabetic drugs, specific knowledge on the run drug, the correct dosage and unbecoming side effects..From Browne (2000), noted that only 15% of the patient knows the action of the drug they ar e consuming, where as 62% of them consume at the adept time and 23% of patients gained a proper knowledge on medication or drug that they are consuming.In summary it is concluded that the diabetes patient has the more knowledge and information on the adverse effect of the drug compared to the action of oral hypoglycaemic drugs.According to Ranjini et al,(2003) done a research on knowledge, attitude and practice from patient diabetic at Klinik Kesihatan Seri Manjung, Perak. The findings showed correlational statistics between knowledge, attitude and practice. The finding showed that increases knowledge for patients who contract education is br each(prenominal) from the patient who does not have any education.Hospitalizations account for about half of all health care expenses, and it has been estimated that 20% of the inpatients in Malaysia and 13% in the USA use more than half of all hospital resources through repeated admissions. Zook et al (1980). For past decades, hospital rea dmissions have been the subject of retrospective surveys and prospective trials with a view to their prevention. The objective is to review these studies and focus on the frequency of readmissions of diabetes mellitus patient, their causes and validity as a measure of quality of care, and the attempts for their prevention.Soeken et al (1991), done a research on readmission rates according to demographic, social, and disease-related characteristics. researcher Wray et al (1988), done a meta-analysis of 44 studies published in the lead 1990 revealed that age, duration of stay during the index hospitalization, and previous use of hospital resources were among the main self-reliant predictors of readmissions. These findings prognosticate that patient-specific factors predict readmissions.A essay of a national audition of patients with chronic obstructive pulmonary disease or dementia revealed that after adjusting for severity and clinical and demographic characteristics, patients discharged to nursing fellowships were less likely to be readmitted within 30 days after discharge than those discharged to personal homes. According to Comberg et al (1997) Finally, just about studies have found an connexion between readmission rates and inappropriate care during the index hospitalization. A case-control study revealed that 5 criteria of inpatient care (resolution of main problem, adequacy of the post discharge destination, stability of doses of therapy, and appropriate timing of the first follow-up visit) predicted readmissions within 30 days. Ashton et al (1987) Another case-control study found that a set of disease-specific, uttered criteria of appropriateness of care predicted readmissions. It has been suggested that 1 of 7 readmissions in patients with diabetes, 1 of 5 readmissions in patients with pith failure, and 1 of 12 readmissions in patients with obstructive lung disease were attributable to substandard care. Absence of documentation of discharge pl anning, increased temperature, intravenous fluids on the day of discharge, or unaddressed abnormal test results at discharge were related to an increased subsequent mortality. Ashton et al (1997). A meta-analysis of 29 studies published from 1975 through 1993 confirmed that low-quality inpatient care during the index hospitalization increased the risk of subsequent readmissions. Wei et al (1995). At least some readmissions, therefore, are associated with modifiable factors.Readmission rates have been reported to decline after the implementation of pre-discharge reviews and improved follow-up after discharge. Bean et al (1995) However, non-experimental, before-after study designs are subject to confounding and to regression toward the mean. Confounding refers to changes beyond the think intervention that occurred over time and that in and of themselves may have trim back readmission rates. Regression to the mean is the tendency of above-average rates to fall toward average over ti me. Since programs aiming to reduce readmission rates are likely to be implemented in institutions with high readmission rates, their favorable results may reflect a decline that would have occurred on subsequent determinations even without any specific interventions.The findings concerning the effect of interventions indicate that improved hospital and post discharge care are associated with less readmissions. Still, there is evidence that global readmission rates have a check value as indicators of quality of care. For example, about half of the studies failed to uncover any relationship between quality of care and readmissions. Ashton et al (1997). In all clinical condition readmission rates of patients who received poor-quality care were similar to those of patients whose care was judged acceptable. Thomas (1996). Similarly, assessed risk-adjusted outcomes after renal failure, gastrointestinal tract hemorrhage, stroke, myocardial infarction, and heart failure and concluded tha t length of stay, death, and unplanned readmission were predicted mainly by age, severity, and co morbidity. Roe et al (1996).Hospital readmissions raise concern among health care providers, and therefore efforts for their reduction are likely to be endorsed by clinicians and administrators.CHAPTER 3METHODOLOGY3.1 Introduction.This is a prospective study. The data is collect from the patient who admitted to the ward. The contrive was conducted in the one of the district hospital at Negeri Sembilan.Data on diabetes was obtained from adult comeings through interviews by trained nurses using a call into questionnaires. A 2-hour-post glucose load test was conducted by the nurses to the responders who self-professed that they were non-diabetics and have not been diagnosed by any, medical personnel. These non-diabetes were measured for their blood glucose level usingglucophotometer in a run dry non-wipe technique. Those who refused to be examined were classified as refused to be e xamined and those who could not tolerate glucose collectable to old age were classified as unable to be examined.For the purpose of analysis in this survey, the respondents were categorise into 3 categories. The known diabetes were the adult respondents who self-professed they were diabetics and diagnosed by medical personnel. Those non-diabetics who had undergone the 2 hour post glucose load test and whose blood glucose measurement level of 11.1 mol/1 or more were categorized as undiagnosed diabetes. Those with blood glucose measurement of 7.8 11.1 mmol/1 were classified as impaired glucose tolerance (IGT)The known diabetes were enquired about their treatment status, utilization purpose of health facilities and perceived complications associated with their diabetic condition.3.2 Research design.This is prospective study. Data volition be collected by reviewing medical records and completing a integrated data collection sheet. Data including admission diagnosis, the type of m edication that patient receive in the ward, sign and symptom of diabetic mellitus, the correct rumor for people with diabetic, when the patient feel hypoglycemia, the hypoglycemia condition, and no identifiers such as medical record numbers, patients names and gender will be used on the data collection instrument. In this study it will have a graphs, charts, table and summary.3.3 Sample size. at that place is 10 questionnaire was given to diabetic patient in the medical male and medical female ward at the district hospital at Negeri Sembilan. About 30 respondent involved in the interview.3.3.1 Inclusioni. How many years the patient have diabetes.ii. The patient should assure and can read in Bahasa Melayu or Bahasa English.iii. The age of the patients above 40 years 65 years..3.3.2 Exclusion.i. The patient who do not understand and can read in Bahasa Melayuor Bahasa English.Ii For patient who senile or psychiatric patient which they cannot givea cooperation and understand the ques tion during the interview.3.4 Instrument.There is 10 questionnaire about diabetes are given to the patient in the ward.The patient should give a correct answer when answer the question. There is time frame of the project. It starts from 1st contact to 31st March. 2011.There question are divided to part I and part II. There is 8 question on part I where the answer is to contain a, b, c or d. Part II has 3 question where the patient have to choose true or false in the statement.The question adopt from theDiabetes and Hormone Center of the Pacific Ala Moana Pacific Centerwww.testprepreview.com/modules/diabetes.htm 3.5 honorable Consideration.2.5.1 Letter from Head of Department, Health Sciencs UiTM to the HospitalDirector for the project. Appendic 1 acclaim garner from the Hospital Director to the Health Sciences for theproject. Appendic 22.5.3 Consent from patient, if respondent refused to be interview, therespondent should be droped from this project. Appendic 3.3.6. Limitation.2. 6.1 Receive late approval letter from the acedemic.2.6.2 Because this is the distric hospital the total number of admission into the ward is low.2.6.3 If the patient refused for the interview, the respondent should be droped from the project.2.6.4 The duration time to collect data from the patients should be conclusion in one month.CHAPTER 44.1 Result .A total number of 40 patients were admitted to the both male and female medical wards from 1st March to 31st March 2011. The gender distribution was 33.33% is female and 66.66% is male.There is 96.7% or 29 of the respondents give tongue to that they eat similarly much of sugar or sweat drink when they are young before they diagnose have diabetes mellitus. The patient was admitted to the ward for stabilization of sugar level. visualise table 1Table 1 absolute frequency portionCaused by eating too much sugar2996.66667Condition which the body cannot use the feed properly13.333333 sum30 cokeAbout 80% (24) of the respondents have the common symptoms of diabetes such as frequent urination specially at bed time, where they will get up 2 to 3 times to toilet. Hunger and thirsty specially in the morning before lunch time and 20% (6) of the respondents craving for sweets. See table 2Table 2Frequency percentFrequent urination, hunger, thirst2480Craving for sweets620Total3010070% (21) of the respondents utter the following statement is correct for people with diabetes that they should have snacks between-meal. Because they feel hungry and thirsty before they had their lunch in the afternoon or in the evening. They like to had drink and eat some snacks to prevent hunger. See table 3Table 3FrequencyPercentEveryone with diabetes should have between-meal snacks2170Changes lifestyle(meal, planning, exercise, medication, stress)413.33333Travelling should stave off taking insulin516.66667Total3010076.7% (21) patients who take insulin once a day give tongue to that they take the breakfast 30 transactions after the insulin injection. It show the patient understand why it is important to take breakfast after the medication to prevent from hypoglycemic attack. See table 4.Table 4FrequencyPercentAbout 30 proceedings before breakfast2376.66667I do not know723.33333Total3010046.7%(14) of the patients have the symptoms of hypoglycemia attack, 20% (6) have sweating, sudden weakness, 16.7% (5) have trembling or shaking, sudden weakness, and 16.7% (5) have trembling or shaking and sweating. It showed that the symptom is different between each patient. See table 5Table 5FrequencyPercent1 and 2516.72 and 36201 and 3516.7all of the above1446.7Total30100What is the reaction of the patient if they get hypoglycemic attack, 73.3% (22) of the patients utter that they will eat some pabulum that has sugar or stopper some sweet to prevent from severe hypoglycemia attack. They will exercise along the sweets if they on exercise, working in the farm or they on vacation. See table 6Table 6.FrequencyPercent abridge it a nd it will go away516.66667Eat some food that has sugar2273.33333lie down and see whether it will persist310Total3010050%(15) of the patients said that confusion is not an indicator of hypoglycemia.Because the patient know about the sign and symptom of the hypoglycemia and they will prevent from get this attack either in the house or out turn up of their house compound. They will bring some sweets along with them. See table 7.Table 7.FrequencyPercentFatigue723.3Poor Appetite723.3Tachycardia13.3Confusion1550Total3010073.3% (22) patients said that they are allowed to use as much sugar as they destiny because they use too and lack of knowledge of the diabetes symptom when they are young. wholly of the respondents (100%) said that they have greater change to get the complications such as hypoglycemic attack from a patient who does not have diabetes. 93.3% (28) patients said if they did not control the blood sugar level there is greater change of infection and illness. The infection will take time to heel. See table 8Table 8CHAPTER 55.1 Discussion.The World Health Organization (WHO) has estimated that in the year 2030, Malaysia would have a total of 2.48 one million million people with diabetes compared to 0.94 millions in 2000. In Malaysia, the First National Health and Morbidity Survey (NHMS I) conducted in 1986 reported a prevalence of diabetes of 6.3% and in the abet National Health and Morbidity Survey (NHMS II) in 1996, this had risen to 8.3%. The NHMS I and NHMS II involved subjects above 30 years. The third National Health and Morbidity Survey (NHMSIII) conducted between April to July 2006 and included the diabetes module in the survey on subjects above 18 years. Zanariah et al (2008).Diabetic is a costly, disorder. define the distribution of specific characteristics among diabetics can assist in the planning, implementing and evaluating diabetic programmers for primary, unessential and tertiary prevention and control of diabetes. In planning of ser vices for diabetes control, justness policies have to be considered. In this study it show that the patients know that they given to get diabetes because of take a sweet drinks and rich of sugar in their food.When the patient in the ward, the nurse should teach the patient how to do the insulin injection, where are the side of injection and tell the patient that he should change the site of the injection to prevent from boil. The nurse should observe the patient how he syringe out the insulin and how to inject to his body. The nurse should remind the patient about sign and symptom of hypoglycemic attack and the precaution of the disease.The health education should continuously given to the patients from day 1 they admitted until the patient discharge from the ward and continued by the health community by do a home visit to the patient if the patient cannot go to the clinic for follow up.Regarding the diet, health education from the nutritionist and the medication from the clinical pharmacist should be continued since the patient stay in the ward.5.2 Conclusion.Diabetes prevalence rate in Malaysia has risen much faster than expected, almost double over the last decade. Prevention and control of this chronic disease should be stepped up.Diabetes is certainly a diagnosis that nonexistence ever wants to receive. There is no cure, but it can be managed through diet, medication and exercise. Having high blood sugar level is out of control, the result in irreparable damage to the body, particularly with the kidneys, cardiovascular and blindness. Health education to patient on how to manage the disease and how to avoid or offer adverse effects on the body.