The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization.

We conclude that the IVIIC is a safe nurse-driven protocol with excellent BG outcomes.

OBJECTIVE:To evaluate contemporary hospital glycemic management in US academic medical centers.DESIGN: This retrospective cohort study was conducted on patients discharged from 37 academic medical centers between July 1 and September 30, 2004; 1,718 eligible adult patients met at least 1 of the inclusion criteria: 2 consecutive blood glucose readings >180 mg/dL within 24 hours, or insulin treatment at any time during hospitalization. We assessed 3 consecutive measurement days of glucose values, glycemic therapy, and additional clinical and laboratory characteristics. RESULTS:In this diverse cohort, 79% of patients had a prior diagnosis of diabetes, and 84.6% received insulin on the second measurement day. There was wide variation in hospital performance of recommended hospital diabetes care measures such as glycosylated hemoglobin (A1C) assessment (range, 3%-63%) and timely admission laboratory glucose measurement (range, 39%-97%). Median glucose was significantly lower for patients in the intensive care unit (ICU) compared to ward/intermediate care. ICU patients treated with intravenous insulin had significantly lower median glucose when compared to subcutaneous insulin. Only 25% of ICU patients on day 3 had estimated 6 AM glucose 110 mg/dL.Hyperglycemia was common, 50% of all patients had !1 glucose measurement !180 mg/dL on measurement days 2 and 3. Severe hypoglycemia (<50 mg/dL) occurred in 2.8% of all patient days. CONCLUSIONS:Despite frequent insulin use, glucose control was suboptimal.

BACKGROUND:Great emphasis is placed on optimizing treatment of hospitalized patients with diabetes and hyperglycemia.OBJECTIVE:This study was conducted to determine if the application of hospital‐wide insulin order sets improved inpatient safety by reducing the number of actual hypoglycemic and hyperglycemic events and increasing at‐target blood glucose.DESIGN:A retrospective chart review was conducted of hypoglycemic and hyperglycemic events and at‐target blood glucose occurring before and after institution of the insulin order sets and blood glucose protocols.SETTING:The Medical University of South Carolina (MUSC) Medical Center is a 709‐bed hospital and tertiary referral center for partnering hospitals in the southeastern United States.PATIENTS:All patients were evaluated who had a documented history of diabetes or who had at least 1 finger‐stick blood glucose above 180 mg/dL who were admitted for care to the MUSC adult main hospital (minimum of 18 years‐of‐age; maximum 100 years‐of‐age) during June 2004, June 2005, June 2006, and June 2007.INTERVENTION:The intervention involved institution of hospital‐wide hypoglycemia, hyperglycemia, subcutaneous insulin, and intravenous insulin treatment protocols.MEASUREMENTS:Retrospective data on hypoglycemia, hyperglycemia, and at‐target blood glucose incidence and frequency were collected via a computerized repository for all inpatients.RESULTS:The percent time in range improved by 10% with no increase in the amount of severe hypoglycemic episodes for the blood glucose results.CONCLUSIONS:Implementing standardized insulin order sets including hypoglycemia and hyperglycemia treatment protocols at MUSC produced expected benefits for patient safety for this patient population. Journal of Hospital Medicine 2009;4:331–339. © 2009 Society of Hospital Medicine.

IN BRIEF Ward management of diabetic ketoacidosis (DKA) using subcutaneous insulin in specific patient populations is safe and effective, but insulin administered by continuous infusion has not been analyzed in this setting. This retrospective cohort study utilizing a nursing-driven, continuous infusion insulin calculator demonstrated safe and effective treatment of patients with DKA on medicine wards.

Abbreviations: (ADA) American Diabetes Association, (BG) blood glucose, (CDE) certified diabetes educator, (CTICU) cardiothoracic intensive care unit, (D50W) 50% dextrose in water, (DKA) diabetic ketoacidosis, (HDTF) hospital diabetes task force, (HHNK) hyperglycemic hyperosmolar nonketotic coma, (HTML) hypertext markup language, (ICU) intensive care unit, (IV) intravenous, (IVI) intravenous insulin, (IVIIC) intravenous insulin infusion calculator, (IVP) intravenous push, (MAR) medication administration record,

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