title: Impact of improvement efforts on glycemic control and hypoglycemia at a university medical center.
abstract: 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.
authors: Department of Medicine/Endocrinology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. hermayer@musc.edu
authors: Kathie L
authors: KL
authors: Hermayer
authors: Patrick
authors: P
authors: Cawley
authors: Pamela
authors: P
authors: Arnold
authors: Angela
authors: A
authors: Sutton
authors: John
authors: J
authors: Crudup
authors: Lisa
authors: L
authors: Kozlowski
authors: Timothy V
authors: TV
authors: Hushion
authors: Maureen L
authors: ML
authors: Sheakley
authors: Juanita A
authors: JA
authors: Epps
authors: Rebecca P
authors: RP
authors: Weil
authors: Rickey E
authors: RE
authors: Carter
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin