Decreased Rates of Inpatient Hypoglycemia Following Implementation of an Automated Tool in the Electronic Medical Record for Identifying Root Causes

Gregory, Naina Sinha; Seley, Jane Jeffrie; Ukena, Jenny; Shah, Sona; Fred, Matthew R.; Dargar, Savira Kochhar; Kim, Robert J.

doi:10.1177/1932296817744808

Cited by 9 publications

(16 citation statements)

References 16 publications

(14 reference statements)

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“…The survey asked them to identify relevant characteristics and causes of the event. It acted as a reflective intervention, as well as identifying root causes to inform targeted topics for brief educational presentations (7). A virtual glycemic management service (vGMS) that generated a daily report of all inpatients with dysglycemia in the last 24 hours.…”

Section: Resultsmentioning

confidence: 99%

A framework for local-level economic evaluation to inform implementation decisions: health service interventions to prevent hospital-acquired hypoglycemia

Gray,

Thynne,

Eaton

et al. 2023

Int J Technol Assess Health Care

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Objectives Published evidence on health service interventions should inform decision-making in local health services, but primary effectiveness studies and cost-effectiveness analyses are unlikely to reflect contexts other than those in which the evaluations were undertaken. A ten-step framework was developed and applied to use published evidence as the basis for local-level economic evaluations that estimate the expected costs and effects of new service intervention options in specific local contexts. Methods Working with a multidisciplinary group of local clinicians, the framework was applied to evaluate intervention options for preventing hospital-acquired hypoglycemia. The framework included: clinical audit and analyses of local health systems data to understand the local context and estimate baseline event rates; pragmatic literature review to identify evidence on relevant intervention options; expert elicitation to adjust published intervention effect estimates to reflect the local context; and modeling to synthesize and calibrate data derived from the disparate data sources. Results From forty-seven studies identified in the literature review, the working group selected three interventions for evaluation. The local-level economic evaluation generated estimates of intervention costs and a range of cost, capacity and patient outcome-related consequences, which informed working group recommendations to implement two of the interventions. Conclusions The applied framework for modeled local-level economic evaluation was valued by local stakeholders, in particular the structured, formal approach to identifying and interpreting published evidence alongside local data. Key methodological issues included the handling of alternative reported outcomes and the elicitation of the expected intervention effects in the local context.

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Section: Resultsmentioning

confidence: 99%

A framework for local-level economic evaluation to inform implementation decisions: health service interventions to prevent hospital-acquired hypoglycemia

Gray,

Thynne,

Eaton

et al. 2023

Int J Technol Assess Health Care

View full text Add to dashboard Cite

show abstract

“…Furthermore, inclusion of standardized insulin administration instructions in the order set should be defaulted in an effort to prevent hypoglycemia. Changes or interruption in nutrition is one of the primary causes of hypoglycemia in the hospital [ 6 , 22 ], so indication and holding parameters for nutritional insulin administration orders should be included in every nutritional insulin order. While basal insulin, if appropriately dosed, should not have to be held if a patient is temporarily NPO, holding parameters can also be specified for added hypoglycemia preventive measures [ 6 ].…”

Section: Insulin Regimens For Variable Nutritional Statusmentioning

confidence: 99%

Electronic Health Record–Based Decision-Making Support in Inpatient Diabetes Management

et al. 2022

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Purpose of Review This review discusses ways in which the electronic health record (EHR) can offer clinical decision support (CDS) tools for management of inpatient diabetes and hyperglycemia. Recent Findings The use of electronic order sets can help providers order comprehensive basal bolus insulin regimens that are consistent with current guidelines. Order sets have been shown to reduce insulin errors and hypoglycemia rates. They can also help set glycemic targets, give hemoglobin A1C reminders, guide weight-based dosing, and match insulin regimen to nutritional profile. Glycemic management dashboards allow multiple variables affecting blood glucose to be shown in a single view, which allows for efficient evaluation of glucose trends and adjustment of insulin regimen. With the use glycemic management dashboards, active surveillance and remote management also become feasible. Hypoglycemia prevention and management are another part of inpatient diabetes management that is enhanced by EHR CDS tools. Furthermore, diagnosis and management of diabetic ketoacidosis and hyperglycemia hyperosmolar state are improved with the aid of EHR CDS tools. Summary The use of EHR CDS tools helps improve the care of patients with diabetes and hyperglycemia in the inpatient hospital setting.

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“…After a brief targeted education, 642 patients postintervention were compared with 566 historical controls showing that threshold hypoglycemia decreased from 2.3% to 1.5% and recurrent hypoglycemia decreased from 5.7% to 2.2%. 24 Auditing the EMR can also help identify processes in need of improvement. A 24-hour hypoglycemia report with all episodes of BG <50 mg/dL was generated by the EMR and reviewed by a diabetes nurse specialist.…”

Section: Auditing the Emrmentioning

confidence: 99%

Inpatient Hypoglycemia: The Challenge Remains

Cruz

2020

J Diabetes Sci Technol

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Hypoglycemia in inpatients with diabetes remains the most common complication of diabetes therapies. Hypoglycemia is independently associated with increased morbidity and mortality, increased length of stay, increased readmission rate, and increased cost. This review describes the importance of reporting and addressing inpatient hypoglycemia; it further summarizes eight strategies that aid clinicians in the prevention of inpatient hypoglycemia: auditing the electronic medical record, formulary restrictions and dose-limiting strategies, hyperkalemia order sets, electronic glucose management systems, prediction tools, diabetes self-management, remote surveillance, and noninsulin medications.

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Decreased Rates of Inpatient Hypoglycemia Following Implementation of an Automated Tool in the Electronic Medical Record for Identifying Root Causes

Cited by 9 publications

References 16 publications

A framework for local-level economic evaluation to inform implementation decisions: health service interventions to prevent hospital-acquired hypoglycemia

A framework for local-level economic evaluation to inform implementation decisions: health service interventions to prevent hospital-acquired hypoglycemia

Electronic Health Record–Based Decision-Making Support in Inpatient Diabetes Management

Inpatient Hypoglycemia: The Challenge Remains

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