Date of Graduation

Fall 12-12-2025

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Department/Program

<--Please Select Department-->

Program

MSN project

First Advisor

Jennifer Zesati, MSN, RN

Abstract

Abstract

Setting: A high acuity emergency department within a large hospital system. Problem: Nurses in the emergency department reported inconsistent understanding and utilization of the existing Diabetic Ketoacidosis (DKA) protocol. Pre-intervention survey results showed that 84% of nurses identified the DKA order set as confusing, and only 15% reported feeling “very comfortable” with the protocol. These knowledge gaps contributed to delays in glucose monitoring, inconsistent insulin administration, uncertainty about order-set responsibilities, and variable adherence to evidence-based management. Context: DKA is a time-sensitive, high-risk emergency that requires precise, protocol-driven actions to prevent complications such as electrolyte imbalance, cerebral edema, prolonged hospitalization, and increased healthcare costs. Standardized, streamlined interventions and staff education are essential for reducing variation and improving safety and workflow efficiency in the ED. Intervention: A targeted education intervention was delivered during pre-shift huddles across day and night shifts. Education clarified the correct DKA order set, roles and responsibilities, insulin and electrolyte management, required hourly glucose checks, equipment access (glucometers, i-STAT), and admission workflow. A pre- and post-survey was used to evaluate changes in staff comfort and perceived barriers. Results: Pre/post comparisons demonstrated improvements in staff familiarity with the protocol, reductions in reported confusion with the order set, and increased comfort in applying the DKA workflow. Staff also reported better clarity regarding insulin ordering, glucose monitoring expectation, and the correct sequence of steps in the DKA management process. Conclusion: A brief, structured educational intervention delivered during the ED pre-shift huddles improved nurses’ comfort and clarity with the DKA protocol. These findings support ongoing reinforcement of DKA education and continued use of standardized protocols to enhance performance and patient safety in the ED.

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