Diabetes, Nursing

Celebrating National Nurses Month and International Nurses Day Part Two: Lorraine (Laurie) Porcaro

Glytec joins the World Health Organization (WHO), the International Council of Nurses (ICN) and the American Nurses Association (ANA) in celebrating the Year of the Nurse in 2021. The ANA has expanded its annual National Nurses Week into National Nurses Month, which it’s celebrating all throughout May. And as it always does, ICN is celebrating International Nurses Day around the world on May 12 to commemorate the anniversary of Florence Nightingale’s birth.

This year’s celebrations seek to reflect on the impact of COVID-19 on healthcare and the nursing profession to show the critical role nurses play in transforming the way care is delivered. As the largest healthcare profession, Nurses have an integral role and must have a voice in planning the future of healthcare.

In honor of the Year of the Nurse, Glytec’s Diabetes Nurse Specialist, Kerri Doucette, RN, RDN, CDCES, is conducting a three-part interview series with nursing professionals that have delivered outstanding clinical support in treating patients with diabetes and glycemic management issues.

Part two of our series is a conversation with Laurie Porcaro, MS-DEDM, RN, CDCES, BC-ADM, Diabetes Clinical Manager at Garnet Health Medical Center’s Dunkelman Diabetes Center. Lorraine (Laurie) Porcaro MS-DEDM, RN CDCES BC-ADM is the Diabetes Clinical Manager at Garnet Health Medical Center in Middletown, New York. She has been a diabetes educator since 1996 and a certified trainer for insulin pumps and continuous glucose monitoring systems.   She has presented at multiple national conferences and is a member of the American Diabetes Association and the Association of Diabetes Care & Education Specialists (ACDES) where she is a member of the ACDES Favorably Reviewed Committee. At Garnet Health she has been the lead for their multidisciplinary Glycemic Improvement Team, which has been dedicated to quality improvements related to inpatient glucose management since 2012. She is committed to the tenet that education and technology drive improved patient outcomes. Click here for part one of the series with Christine Dignan, BSN, RN, Certified Diabetes Care and Education Specialist (CDCES), Sentara Obici Hospital. 

Kerri Doucette: Why is 2021 such an important time to raise the visibility of the critical role nurses have in delivering care and education for people struggling with glycemic management?

Laurie Porcaro: This is such an important time because the pandemic has affected all of us in so many ways. We’ve seen it impact the availability of medical supplies and medication, limit access to clinical care, and elevate the importance of infection prevention. COVID-19 has also illuminated the effect poor glycemic management has on health outcomes and the importance of patient education.

People living with diabetes and poorly managed glucose have exhibited worse COVID-19 symptoms and complications. What’s more, the most common treatment protocols call for the use of high-dose steroids that make patients more susceptible to incidences of hyperglycemia. Diabetes management is also negatively impacted by increased levels of stress and a sedentary lifestyle, and the pandemic has made it difficult for people living with diabetes to reduce stress and exercise regularly to properly manage their blood glucose.

Nurses must ensure people with diabetes understand the necessary steps they must take to protect themselves and others from COVID-19, which includes encouraging them to get immunized. Nurses can encourage healthy habits, such as home exercise, healthy eating, proper glucose monitoring, and taking medications regularly. Nurses can also help identify support systems for the increasing number of people that feel isolated due to COVID-19. As educators, nurses can teach people with diabetes how to manage sick days, when to contact their medical provider, and help to develop action plans for illness and emergencies.

KD: What are some examples of your hospital or health system embracing glycemic management technology to empower its nursing staff?

LP: Our hospital uses technology to track unit-by-unit and overall hospital glycemic outcomes. These results have guided many interventions, which are led by our interdisciplinary Glycemic Improvement Team. The Glycemic Improvement Team has included at least one registered nurse since its inception, as nurses are integral to implementing the necessary changes to improve patient care.

The data from this technology allows our Glycemic Improvement Team to initiate hospital-wide improvements. For example, one element of the data we receive enables us to track nursing reassessment of glucose after treating a hypoglycemic event. Based on monthly results, the Glycemic Improvement Team has updated the protocol for the treatment of hypoglycemia and provides targeted education to the nursing staff. Our nurses are then able to leverage this improved knowledge base to treat hypoglycemia confidently and independently, and reassess in a timely manner. We have been very successful in this endeavor, and our project is featured by the Society of Hospital Medicine for Glycemic Control for Hospitalists.

We deployed the Glytec Glucommander eGlycemic Management System in early 2015 to guide IV insulin infusion therapy in our Emergency Department and Critical Care units. Our nurses have become experts in its use, which has led to dramatic reductions in both our time to target and incidences of hypoglycemia. In my role as Diabetes Clinical Manager, I rely on Glytec’s GlucoSurveillance® system for real-time systems oversight and comprehensive data reports. I share these insights with the treatment team and nursing administrators each morning to drive interventions and informed decisions that improve patient care.

KD: The theme of this year’s International Nurses’ Day is to highlight the ways nurses are innovating and provide a glimpse into what the future of nursing may look like. Given the developments and innovations over the past year, how do you see the role of the nurse evolving in terms of glycemic management?

LP: Nurses must continue to advocate for the implementation of new technologies that improve patient care. I anticipate we will see the use of highly developed CGMs in both the outpatient and inpatient settings that integrate with glucose management software to automatically adjust insulin doses – and perhaps even oral medications – based on the patient’s response to therapy. I hope in my lifetime that there will be automated systems that not only improve patient outcomes, but simplify clinical management, reduce the amount of nursing interventions, and ease the burden of diabetes self-care. No matter how advanced these systems are, though, nurses will always have a critical role in diabetes care. We will always be there to advocate for our patients and to educate, encourage and inspire persons living with diabetes.

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