Improving Inpatient Glycemic Control Using a Multifaceted Approach

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97722

Background:

Nationally, manifestations of poor glycemic control are one of Medicare’s Hospital Acquired Conditions that are publically reported and no longer reimbursed. Insulin is also one of the JC’s top five high –risk medications. Furthermore, poor glycemic control has been associated with negative patient outcomes. Therefore, initiatives to improve inpatient glycemic control are necessary. Basal–bolus insulin regimens are proven as one means to accomplish this task. We therefore implemented a multi–faceted approach to improve glycemic control.

Purpose:

To improve inpatient glycemic control across a 3 hospital system using a multi–faceted care approach.

Description:

Analysis showed poor glycemic control (including hypo and hyperglycemia) and poor standardization on glycemic medication utilization. As part of SHM’s Glycemic Control Mentored Implementation Program we designed a multi–faceted approach to improve inpatient management of hyperglycemia. A multi–disciplinary team (hospitalists, endocrinologists, nursing, nursing educators, QI leaders, and pharmacists) developed a 3 three prong initiative including CPOE insulin care set development, focused physician and nursing education, and meal delivery/POC testing process redesign. The result was a new CPOE insulin care set structuring physician insulin ordering by dietary status i.e. NPO, eating, or tube feeds. The care set follows an algorithmic structure with pre–selected and pre–dosed basal insulin orders based on patients’ estimated level of insulin resistance. The basal insulin order is then married with the appropriate prandial scale based on estimated levels of insulin resistance. The prandial scales combine nutritional and correctional fast–acting insulin doses into one efficient scale allowing for appropriate insulin regimen dosing, simplified nursing administration, and less room for errors. The new care set was launched in conjunction with a free on–line CME educational activity to educate physicians on the evidence surrounding inpatient basal–bolus insulin regimens. In addition, live conferences were held and computer screen savers designed to raise awareness surrounding the importance of inpatient glycemic control. Concurrently, nursing education regarding glycemic control and safe insulin administration was led by nursing leadership and endocrinology. Finally, one medical unit underwent meal delivery/POC testing process redesign to enhance insulin safety.

Conclusions:

Our multi–faceted approach to improving the efficacy and safety of the management of inpatient diabetes has resulted in raised awareness of the importance of inpatient glycemic control, evidence–based standardization of inpatient hyperglycemic management, decreases in inpatient hyperglycemia without increases in hypoglycemia, and increased safety of insulin administration.

To cite this abstract:

Seiler A, Paddleford B, Desgres C, Taylor E, Rogalski M, Calcasola S, Reddy V, Whitcomb W. Improving Inpatient Glycemic Control Using a Multifaceted Approach. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97722. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/improving-inpatient-glycemic-control-using-a-multifaceted-approach/. Accessed July 21, 2019.

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