Impact of improvement efforts on glycemic control and hypoglycemia at a university medical center.
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.


METHODS
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.


METHODS
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.


METHODS
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.


METHODS
The intervention involved institution of hospital-wide hypoglycemia, hyperglycemia, subcutaneous insulin, and intravenous insulin treatment protocols.


METHODS
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.
Hermayer
Kathie L
KL
Department of Medicine/Endocrinology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. hermayer@musc.edu
Cawley
Patrick
P
Arnold
Pamela
P
Sutton
Angela
A
Crudup
John
J
Kozlowski
Lisa
L
Hushion
Timothy V
TV
Sheakley
Maureen L
ML
Epps
Juanita A
JA
Weil
Rebecca P
RP
Carter
Rickey E
RE
D000046:Academic Medical Centers / Q000379:methods / Q000592:standards*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D005260:Female; D038321:Glycemic Index / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000188:drug therapy / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000592:standards; D007328:Insulin / Q000008:administration & dosage / Q000592:standards; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D012189:Retrospective Studies; D013022:South Carolina
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin