title: A real-time nursing intervention reduces dysglycemia and improves best practices in noncritically ill hospitalized patients.
abstract: BACKGROUND
  Dysglycemia is prevalent in hospitalized patients and is associated with poor clinical outcomes. Educational interventions insufficiently improve best practices in managing dysglycemia.
  
  
  OBJECTIVE
  To reduce dysglycemia by improving best practices for inpatient glycemic control.
  
  
  METHODS
  Interrupted time series.
  
  
  METHODS
  A community teaching hospital.
  
  
  METHODS
  A total of 653 adult, noncritically ill, nonobstetric patients.
  
  
  METHODS
  A real-time nursing intervention (RTNI). A charge nurse issued a verbal invitation to the physician to utilize the existing glycemic control order set for patients with dysglycemia.
  
  
  METHODS
  (1) Lone correctional insulin (LCI) usage; (2) potentially inappropriate oral hypoglycemic medication (PIOHM) usage; (3) patient day-weighted mean glucose (PDWMG; ie, mean glucose for each hospital day, averaged across all hospital days); (4) the percent of patients with PDWMG >180 mg/dL; and (5) the prevalence of severe hypoglycemia.
  
  
  RESULTS
  The use of LCI regimens decreased from 48% to 30% (P < 0.01) during the RTNI period and the rate of potentially inappropriate oral hypoglycemic medications (PIOHMs) usage was reduced from 29% to 13% (P < 0.01). PDWMG decreased from 166 mg/dL to 156 mg/dL (P = 0.04). After removal of the RTNI, outcome measures were not significantly different from baseline, with the exception of PIOHM use, which remained lower at 19% in the postintervention group (P = 0.04).
  
  
  CONCLUSIONS
  An RTNI promoting a best-practice glycemic control order set was successful in modestly lowering mean glucose levels and substantially reducing the use of LCI and PIOHMs.
authors.affiliation: Department of Medicine, Emory Johns Creek Hospital, Johns Creek, Georgia 30097, USA. hasan.shabbir@ emoryhealthcare.org
authors.forename: Hasan
authors.initials: H
authors.lastname: Shabbir
authors.forename: Jason
authors.initials: J
authors.lastname: Stein
authors.forename: David
authors.initials: D
authors.lastname: Tong
authors.forename: Vikas
authors.initials: V
authors.lastname: Bhalla
authors.forename: Alan
authors.initials: A
authors.lastname: Wang
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D038321:Glycemic Index; D006764:Hospitals, Community; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000451:nursing; D008297:Male; D008875:Middle Aged; D009736:Nursing Process / Q000458:organization & administration* / Q000592:standards; D015397:Program Evaluation; D011787:Quality of Health Care; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose