2.50
Hdl Handle:
http://hdl.handle.net/10755/203188
Type:
Presentation
Title:
Preventing and Treating Hypoglycemia
Abstract:
(Summer Institute) Problem: Thirty percent of our hospital system’s inpatient days have a diagnosis of diabetes. Ninety percent of all hypoglycemia events occur during 9pm-7am. Need to improve inpatient diabetic management as evidence by: a) Multiple events related to poor patient outcomes related to hypoglycemia. b) Poor compliance with nursing staff following hypoglycemia delegated orders. c) Lack of measurable data related to hypoglycemia events. Evidence: Hypoglycemia is a serious concern for healthcare providers. Prevention, early recognition and treatment is critical. Studies have associated hypoglycemia with increased mortality rates. Strategy: a) Develop a system wide multidisciplinary diabetic committee to include nursing, pharmacy, physician, laboratory, quality, and dietary representation to review our current diabetic practices. b) Research literature and revise diabetic practice guidelines and order sets with evidence- based practices to be implemented at our six hospitals. c) Develop a process to measure patient outcomes related to diabetes management and hypoglycemia events including compliance with hypoglycemia delegated orders. a) Develop a system wide multidisciplinary diabetic committee to include nursing, pharmacy, physician, laboratory, quality, and dietary representation to review our current diabetic practices. b) Research literature and revise diabetic practice guidelines and order sets with evidence- based practices to be implemented at our six hospitals. c) Develop a process to measure patient outcomes related to diabetes management and hypoglycemia events including compliance with hypoglycemia delegated orders. Practice Changes: 1. Revisions to Hypoglycemia Delegated Orders: a) Decrease length and confusion b) Prevent reoccurrence 2. Revisions to Sliding Scale Insulin Order set: a) Decreasing the HS dose of fast or rapid acting insulin to ½ dose. b) HS snack if HS BG <110. Evaluation: Evaluation is an ongoing process. Data collection includes monthly: a) Percentages of total FSBG for each hospital for the following ranges: <50, 51-70, 71-180, 181-300, >300; b) Compliance with hypoglycemia delegated orders. Results: Monthly data on severe hypoglycemia rates of all finger stick blood glucose has continued to decrease from an average of .8% to .6%. Recommendations: The work of the System Diabetic Committee is ongoing. Additional evidence based practices changes have been identified which include changes to our current diabetic management practices related to insulin administration. This will require increased physician participation in this committee. Lessons Learned: a) Education was provided prior to implementation of revised hypoglycemia delegated orders and sliding scale orders but follow-up on compliance and continued education must be ongoing. b) Increased physician participation in this committee. Bibliography: Moghissi, E., Korytkowski, M.T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I.B…. Umpierrez, G.E. (2009). American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on inpatient glycemic control. Endocrine Practice, 15(4), 353-369.. Maynard, G., Huynh, M., & Renvall, M. Iatrogenic Inpatient Hypoglycemia: Risk Factors, treatment, and prevention: Analysis of current practice at an Academic Medical Center with implications for improvement efforts. (2008). Diabetes Spectrum, 21, 241–247. Available from: http://spectrum.diabetesjournals.org/content/22/4/241 Society of Hospital Medicine. (2008). Workbook for improvement: Improving glycemic control preventing hypoglycemia and optimizing care of inpatient with hyperglycema and diabetes. Available from: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Quality_Improvement_Resource_Rooms&Template=/CM/HTMLDisplay.cfm&contentID=12029 [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Treating; Hypoglycemia
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePreventing and Treating Hypoglycemiaen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203188-
dc.description.abstract(Summer Institute) Problem: Thirty percent of our hospital system’s inpatient days have a diagnosis of diabetes. Ninety percent of all hypoglycemia events occur during 9pm-7am. Need to improve inpatient diabetic management as evidence by: a) Multiple events related to poor patient outcomes related to hypoglycemia. b) Poor compliance with nursing staff following hypoglycemia delegated orders. c) Lack of measurable data related to hypoglycemia events. Evidence: Hypoglycemia is a serious concern for healthcare providers. Prevention, early recognition and treatment is critical. Studies have associated hypoglycemia with increased mortality rates. Strategy: a) Develop a system wide multidisciplinary diabetic committee to include nursing, pharmacy, physician, laboratory, quality, and dietary representation to review our current diabetic practices. b) Research literature and revise diabetic practice guidelines and order sets with evidence- based practices to be implemented at our six hospitals. c) Develop a process to measure patient outcomes related to diabetes management and hypoglycemia events including compliance with hypoglycemia delegated orders. a) Develop a system wide multidisciplinary diabetic committee to include nursing, pharmacy, physician, laboratory, quality, and dietary representation to review our current diabetic practices. b) Research literature and revise diabetic practice guidelines and order sets with evidence- based practices to be implemented at our six hospitals. c) Develop a process to measure patient outcomes related to diabetes management and hypoglycemia events including compliance with hypoglycemia delegated orders. Practice Changes: 1. Revisions to Hypoglycemia Delegated Orders: a) Decrease length and confusion b) Prevent reoccurrence 2. Revisions to Sliding Scale Insulin Order set: a) Decreasing the HS dose of fast or rapid acting insulin to ½ dose. b) HS snack if HS BG <110. Evaluation: Evaluation is an ongoing process. Data collection includes monthly: a) Percentages of total FSBG for each hospital for the following ranges: <50, 51-70, 71-180, 181-300, >300; b) Compliance with hypoglycemia delegated orders. Results: Monthly data on severe hypoglycemia rates of all finger stick blood glucose has continued to decrease from an average of .8% to .6%. Recommendations: The work of the System Diabetic Committee is ongoing. Additional evidence based practices changes have been identified which include changes to our current diabetic management practices related to insulin administration. This will require increased physician participation in this committee. Lessons Learned: a) Education was provided prior to implementation of revised hypoglycemia delegated orders and sliding scale orders but follow-up on compliance and continued education must be ongoing. b) Increased physician participation in this committee. Bibliography: Moghissi, E., Korytkowski, M.T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I.B…. Umpierrez, G.E. (2009). American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on inpatient glycemic control. Endocrine Practice, 15(4), 353-369.. Maynard, G., Huynh, M., & Renvall, M. Iatrogenic Inpatient Hypoglycemia: Risk Factors, treatment, and prevention: Analysis of current practice at an Academic Medical Center with implications for improvement efforts. (2008). Diabetes Spectrum, 21, 241–247. Available from: http://spectrum.diabetesjournals.org/content/22/4/241 Society of Hospital Medicine. (2008). Workbook for improvement: Improving glycemic control preventing hypoglycemia and optimizing care of inpatient with hyperglycema and diabetes. Available from: http://www.hospitalmedicine.org/AM/Template.cfm?Section=Quality_Improvement_Resource_Rooms&Template=/CM/HTMLDisplay.cfm&contentID=12029 [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectTreatingen_GB
dc.subjectHypoglycemiaen_GB
dc.date.available2012-01-16T11:02:18Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:02:18Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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