Glycemic control in hospitalized patients can improve outcomes and shorten length of stay, whereas hypoglycemia can raise in‐hospital mortality. To improve glycemic control in our tertiary‐care academic hospital, we initiated a multidisciplinary quality improvement process on an adult inpatient unit where approximately one third of patients receive insulin.
The primary objective was to evaluate our current inpatient process of insulin monitoring and administration and to determine timing from blood glucose monitoring to insulin administration and then to bedside meal delivery. A second objective was to create work flows that would allow for this process to be completed within 30 minutes.
We used time‐in‐motion studies and process mapping to quantitate and define our current process and to assist in suggesting interventions. Data were collected over 1 year. We found a number of discrepancies with blood glucose (BG) determination, meal tray delivery, and insulin administration. Our time‐in‐motion studies showed that staff obtained blood glucose readings > 30 minutes prior to a meal 49% of the time, ranging from 166 minutes before a meal to 98 minutes after a meal. Meal timing was inconsistent; delivery to floor varied by 15–30 minutes each day, followed by tray audits that took 15 minutes on average. The entire process from BG determination to insulin administration was completed in <30 minutes for 39% of patients, 30–60 minutes for 39% of patients, and >60 minutes for 22% of patients. Using this data and reviewing our process map at multidisciplinary team meetings, we designed and instituted several interventions including standardization of clinical processes and meal delivery times. This decreased the average time from BG monitoring to bedside meal delivery from 44 to 37 minutes, and patients receiving insulin within 30 minutes of BG increased from 39% to 65%. Configuring staffing assignments into teams was suggested as an additional strategy. Staffing assignments have recently been reconfigured so that nurses have taken over the entire process of BG monitoring, meal delivery, and insulin administration. After this additional change, the average time from BG monitoring to bedside meal delivery decreased from 37 minutes to 14 minutes, and patients receiving insulin within 30 minutes of BG increased to 97%.
This multidisciplinary quality improvement project improved glycemic control in our hospital by standardization of processes including meal delivery time. A nurse‐driven process of BG monitoring, meal delivery, and insulin administration coupled with education, policies, and process changes resulted in significant improvement in timing between BG monitoring and insulin administration and near 100% adherence to guidelines.
K. Rogers ‐ none; R. Matonti ‐ none; S. Hoeppner ‐ none
To cite this abstract:Rogers K, Matonti R, Hoeppner S. Improving Glycemic Control in the Hospital with a Multidisciplinary Quality Improvement Process. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 199. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/improving-glycemic-control-in-the-hospital-with-a-multidisciplinary-quality-improvement-process/. Accessed July 22, 2019.