Development of nursing practice guidelines for screening and caring for diabetic patients at risk of metformin-associated lactic acidosis (MALA), Accident, Emergency and Forensic Department, Kosum Phisai Hospital.

Abstract

      This study was action research aimed at developing nursing practices for screening and caring for diabetic patients at risk of Metformin-Associated Lactic Acidosis (MALA) in the Emergency, Trauma, and Forensic departments of Kosumphisai Hospital. The participants included 16 professional nurses and 128 diabetic patients taking Metformin, selected through accidental sampling between October 2024 and September 2025. The research instruments comprised a patient history and MALA risk assessment form, a nursing practice compliance evaluation form, and a questionnaire assessing nurses’ satisfaction with the developed practices. Data were analyze by descriptive statistic.

      The results indicated that 64.06% of nurses fully complied with the screening and care guidelines, while 75–87.5% reported high to very high satisfaction with the developed practices. Among the screened patients, 29.69% were identified as at risk for MALA, most of whom were aged 51 years or older, had co morbidities such as chronic kidney disease and hypertension, and had been taking Metformin for over ten years. Patients diagnosed with MALA were primarily males aged 60 or older, widowed, engaged in agriculture, with primary-level education, having a diabetes duration of 6–15 years, and receiving Metformin for 10–15 years. Co morbidities commonly included hypertension and stage 2 chronic kidney disease, though some patients had no comorbid conditions. Presenting symptoms included diarrhea, abdominal discomfort, nausea, vomiting, fatigue, anorexia, and in some cases, fever, chills, and body pain.