Impact of improvement efforts on glycemic control and hypoglycemia at a University Medical Center

Abstract

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.

Implementing and Evaluating a Multicomponent Inpatient Diabetes Management Program: Putting Research into Practice

“…Multiple glycemic management educational interventions, including case-based learning modules and lectures for nursing and providers 5–9 and dietitians, were implemented to improve insulin-prescribing practices and glycemic outcomes.…”

Modeling Inpatient Glucose Management Programs on Hospital Infection Control Programs: An Infrastructural Model of Excellence

“…Among 13 studies that evaluated glucometrics, 5 (~40%) showed reductions in hypoglycemia rates and 9 (~70%) showed reductions in hyperglycemia rates. Among the 9 studies showing a reduction in hyperglycemia rates, there was an accompanying increase in hypoglycemia rates in 2 studies 69,70 (~20%), a decrease in two studies 71,72 (~20%), and no change in 5 studies 73–77 (~60%). Generally, favorable changes in insulin-prescribing practices were demonstrated, with increased use of basal-bolus insulin in place of prolonged use of sliding-scale monotherapy.…”

Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry

“…A well designed order set facilitates individualization of patient care. Guidelines may be appended to or embedded within order sets, together with references to supportive medical literature (Donaldson et al 2006;Hermayer et al, 2009;Lee et al 2008;Maynard et al, 2009;Schnipper et al, 2010;Trujillo et al, 2008;Wexler et al, 2010). Protocols executed through order sets were thought to reduce medical errors, improve safety, and increase adherence to those guidelines that were supported by medical evidence.…”