Safety And Efficacy of An Algorithm-Based Protocol In the Management of Diabetic Ketoacidosis

Maghrabi, Adam H.; Hamoudeh, Eyad; Hassan, Tamer; Gress, Todd; Yaqub, Abid; Saleem, Tipu Faiz

doi:10.4158/ep12023.or

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…This accomplishment occurred through use of standardized DKA guidelines built on a two-bag fluid system, standardization of hand-offs, inclusion and education of all stakeholders, and explicit EMR orders to support clinical practice. While previous retrospective studies evaluating use of standardized management of DKA with or without two bag fluid system indicate the potential for decreased cost, 4,13,14 more rapid DKA resolution, 5,15 and/or decreased rates of hypoglycemia 5,7,8 ; to our knowledge, our study is the first to demonstrate how various tenets of quality improvement science can be prospectively paired with the implementation of standardized DKA guidelines based on a two-bag fluid system with the primary objective to decrease the rate of low BGs in pediatric patients with DKA.…”

Section: Discussionmentioning

confidence: 99%

“…Retrospective studies have concluded two bag-fluid systems, as compared to traditional single IV bag treatment methods, allow for quicker resolution of acidosis 5,6 and decreased rates of hypoglycemia. 5,7,8 However, no previous studies have prospectively implemented standardized DKA guidelines built on a two-bag system with the primary objective to reduce the occurrence of low blood glucoses (i.e., BG < 80 mg/dl).…”

Section: Piloting Of 6 Th Guidelines and Increased Incident Reportsmentioning

confidence: 99%

“…At standardized BG thresholds, the rate that each fluid bag is infused into the patient's IV's can be adjusted, this flexibility allows for immediate bedside customization of the overall dextrose concentration infused into the patient. Retrospective studies have concluded two bag‐fluid systems, as compared to traditional single IV bag treatment methods, allow for quicker resolution of acidosis 5,6 and decreased rates of hypoglycemia 5,7,8 . However, no previous studies have prospectively implemented standardized DKA guidelines built on a two‐bag system with the primary objective to reduce the occurrence of low blood glucoses (i.e., BG < 80 mg/dl).…”

Section: Introductionmentioning

confidence: 99%

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Standardized hospital management of pediatric diabetic ketoacidosis reduces frequency of low blood glucose episodes

et al. 2021

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Objective In patients treated for DKA, decrease the rate of visits experiencing one or more BG < 80 mg/dl by 10% within 24 months. Research Design and Methods Plan‐do‐study‐act cycles tested interventions linked to key drivers including: standardized DKA guidelines incorporating a two‐bag fluid system, efficient ordering process, and care team education. Inclusion criterion: treatment for DKA with a bicarbonate value (HCO3) <15 mEq/L. Primary outcome: the percent of patient visits experiencing a BG < 80 mg/dl while undergoing treatment for DKA. Process measures included: order panel and order set utilization rates. Balancing measures included: emergency department and hospital lengths of stay, time to acidosis resolution (time to HCO3 ≥ 17 mEq/L), and admission rates. Outcomes were analyzed using statistical process control charts. Results From January 2017 through May 2021, our institution treated 288 different patients during 557 visits for suspected DKA. Following our interventions, the overall percent of patient visits for DKA with a BG < 80 mg/dl improved from 32% to 5%. The team did see small improvements in emergency department and hospital lengths of stay; otherwise, there was no significant change in our balancing measures. Conclusions Use of quality improvement methodology and standardized DKA management resulted in a significant reduction of BG < 80 mg/dl in patients treated for DKA.

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Section: Discussionmentioning

confidence: 99%

Section: Piloting Of 6 Th Guidelines and Increased Incident Reportsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Standardized hospital management of pediatric diabetic ketoacidosis reduces frequency of low blood glucose episodes

et al. 2021

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“…Literature data confirm the benefits of using appropriate algorithms in DKA treatment. 22,23 However, medical staff does not always follow the guidelines.…”

Section: Patients and Methods Study Populationmentioning

confidence: 99%

Nonadherence to the protocol regarding potassium replacement results in prolonged diabetic ketoacidosis management

Cieluch¹,

Uruska²,

Falkowski³

et al. 2018

Polish Archives of Internal Medicine

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Introduction Diabetic ketoacidosis is a life-threatening condition that requires prompt management. Objectives We aimed to assess the impact of adherence to potassium replacement protocol according to the guidelines of Diabetes Poland on the duration of diabetic ketoacidosis (DKA) treatment. Patients and methods This retrospective analysis included 242 adults (median age, 27 years; range, 21-38 years). Nonadherence to potassium replacement protocol was assessed, along with the relationship between nonadherence and duration of DKA management. Nonadherence to the protocol was defined as too low or too high doses of potassium compared with the recommended potassium replacement protocol. Results The median duration of DKA treatment was longer in the nonadherent group than in the adherent group: 37 hours (interquartile range [IQR], 27-48) and 30 hours (IQR, 17-43), respectively (P = 0.005). Treatment duration correlated positively with nonadherence to potassium replacement protocol (r = 0.18; P = 0.005) and severity of DKA (r = 0.52; P <0.0001). Stepwise multivariate linear regression analysis indicated nonadherence to the protocol (β = 0.14; P = 0.02) and severity of DKA (β = 0.43; P <0.0001) as predictors of treatment duration, after adjustment for body mass index and age (R2 = 0.28; P <0.0001). Conclusions Nonadherence to potassium replacement protocol leads to prolongation of DKA management. Medical staff should be educated about the benefits of potassium replacement and precision in potassium administration and dosing in patients with DKA.

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“…Hyperglycemic crisis protocols have shown mixed results regarding the incidence of hypoglycemia after implementation, with higher, lower, and unchanged occurrence being reported (4–7). Additionally, when surveyed, most nurses found a hyperglycemic crisis protocol difficult to follow (5). Therefore, our opinion is that QI efforts to supplement institutional protocols and health care provider education are warranted.…”

Section: What Lessons Did You Learn Through Your Qi Process That You mentioning

confidence: 99%

Integration of Around-the-Clock Clinical Pharmacy Specialists Into the Critical Care Team Can Increase Safety of Hyperglycemic Crisis Management

et al. 2019

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IN BRIEF “Quality Improvement Success Stories” are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an effort to improve the safety of hyperglycemic crisis management at a Veterans Affairs Medical Center by making clinical pharmacy specialists available to the critical care team 24 hours/day.

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Safety And Efficacy of An Algorithm-Based Protocol In the Management of Diabetic Ketoacidosis

Cited by 5 publications

References 26 publications

Standardized hospital management of pediatric diabetic ketoacidosis reduces frequency of low blood glucose episodes

Standardized hospital management of pediatric diabetic ketoacidosis reduces frequency of low blood glucose episodes

Nonadherence to the protocol regarding potassium replacement results in prolonged diabetic ketoacidosis management

Integration of Around-the-Clock Clinical Pharmacy Specialists Into the Critical Care Team Can Increase Safety of Hyperglycemic Crisis Management

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