title: Multifaceted approach to reducing occurrence of severe hypoglycemia in a large healthcare system.
abstract: OBJECTIVE
  Substantial reductions in inpatient episodes of severe hypoglycemia achieved by a large healthcare system through enhanced use of technology and sustained quality-improvement initiatives are described.
  
  
  CONCLUSIONS
  After internal data collection and analysis revealed that severe hypoglycemia accounted for 75% of all systematically monitored adverse drug events in its hospital network, St. Louis-based BJC HealthCare designed and executed a multifaceted approach to reducing hypoglycemia events. Initiated by a pharmacist-led task force, the project entailed (1) automated event detection and creation of dashboards for comparing hypoglycemia rates among at-risk patients at 11 BJC facilities, (2) implementation of evidence-based and internal best practices in use at BJC's top-performing hospitals, (3) development of an online "Hypoglycemic Event Analysis Tool" (HEAT) to support event investigation and collection of data on causative factors, and (4) the assembly of targeted interventions at a "Hypoglycemia Facility Strategy Tracking" (H-FaST) intranet site. As a result of the launch of the HEAT and H-FaST tools and associated provider education activities, the systemwide rate of hypoglycemia events in the specified at-risk patient population declined from 6.45 per 1000 patient-days during a preimplementation baseline period (July-December 2009) to 1.32 per 1000 patient-days during a designated postimplementation period (January-June 2014), an 80% overall reduction in hypoglycemia (p < 0.01); reductions in severe hypoglycemia events ranging from 70% to 100% were observed at all 11 hospitals.
  
  
  CONCLUSIONS
  A multifaceted, evidence-based, data-driven approach enabled a large healthcare system to markedly reduce the frequency of severe hypoglycemia events.
authors.affiliation: Paul E. Milligan, Pharm.D., is Medication Safety Pharmacist, BJC HealthCare, St. Louis, MO, and Washington University School of Medicine, St. Louis. Mary C. Bocox, M.P.H., M.Ed., is Clinical Epidemiologist, BJC HealthCare. Elizabeth Pratt, D.N.P., RN, ACNS-BC, is Research Scientist, Nurse Specialist, Barnes-Jewish Hospital, St. Louis. Christine M. Hoehner, Ph.D., M.S.P.H., is Epidemiologist Supervisor, Quality Analytics, BJC HealthCare. John E. Krettek, M.D., Ph.D., is Vice President, Clinical Improvement, BJC HealthCare. Wm. Claiborne Dunagan, M.D., M.S., is Professor of Medicine, Washington University School of Medicine, and Senior Vice President and Chief Clinical Officer, BJC HealthCare. paul.milligan@bjc.org.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Milligan
authors.affiliation: Paul E. Milligan, Pharm.D., is Medication Safety Pharmacist, BJC HealthCare, St. Louis, MO, and Washington University School of Medicine, St. Louis. Mary C. Bocox, M.P.H., M.Ed., is Clinical Epidemiologist, BJC HealthCare. Elizabeth Pratt, D.N.P., RN, ACNS-BC, is Research Scientist, Nurse Specialist, Barnes-Jewish Hospital, St. Louis. Christine M. Hoehner, Ph.D., M.S.P.H., is Epidemiologist Supervisor, Quality Analytics, BJC HealthCare. John E. Krettek, M.D., Ph.D., is Vice President, Clinical Improvement, BJC HealthCare. Wm. Claiborne Dunagan, M.D., M.S., is Professor of Medicine, Washington University School of Medicine, and Senior Vice President and Chief Clinical Officer, BJC HealthCare.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Bocox
authors.affiliation: Paul E. Milligan, Pharm.D., is Medication Safety Pharmacist, BJC HealthCare, St. Louis, MO, and Washington University School of Medicine, St. Louis. Mary C. Bocox, M.P.H., M.Ed., is Clinical Epidemiologist, BJC HealthCare. Elizabeth Pratt, D.N.P., RN, ACNS-BC, is Research Scientist, Nurse Specialist, Barnes-Jewish Hospital, St. Louis. Christine M. Hoehner, Ph.D., M.S.P.H., is Epidemiologist Supervisor, Quality Analytics, BJC HealthCare. John E. Krettek, M.D., Ph.D., is Vice President, Clinical Improvement, BJC HealthCare. Wm. Claiborne Dunagan, M.D., M.S., is Professor of Medicine, Washington University School of Medicine, and Senior Vice President and Chief Clinical Officer, BJC HealthCare.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pratt
authors.affiliation: Paul E. Milligan, Pharm.D., is Medication Safety Pharmacist, BJC HealthCare, St. Louis, MO, and Washington University School of Medicine, St. Louis. Mary C. Bocox, M.P.H., M.Ed., is Clinical Epidemiologist, BJC HealthCare. Elizabeth Pratt, D.N.P., RN, ACNS-BC, is Research Scientist, Nurse Specialist, Barnes-Jewish Hospital, St. Louis. Christine M. Hoehner, Ph.D., M.S.P.H., is Epidemiologist Supervisor, Quality Analytics, BJC HealthCare. John E. Krettek, M.D., Ph.D., is Vice President, Clinical Improvement, BJC HealthCare. Wm. Claiborne Dunagan, M.D., M.S., is Professor of Medicine, Washington University School of Medicine, and Senior Vice President and Chief Clinical Officer, BJC HealthCare.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hoehner
authors.affiliation: Paul E. Milligan, Pharm.D., is Medication Safety Pharmacist, BJC HealthCare, St. Louis, MO, and Washington University School of Medicine, St. Louis. Mary C. Bocox, M.P.H., M.Ed., is Clinical Epidemiologist, BJC HealthCare. Elizabeth Pratt, D.N.P., RN, ACNS-BC, is Research Scientist, Nurse Specialist, Barnes-Jewish Hospital, St. Louis. Christine M. Hoehner, Ph.D., M.S.P.H., is Epidemiologist Supervisor, Quality Analytics, BJC HealthCare. John E. Krettek, M.D., Ph.D., is Vice President, Clinical Improvement, BJC HealthCare. Wm. Claiborne Dunagan, M.D., M.S., is Professor of Medicine, Washington University School of Medicine, and Senior Vice President and Chief Clinical Officer, BJC HealthCare.
authors.forename: John E
authors.initials: JE
authors.lastname: Krettek
authors.affiliation: Paul E. Milligan, Pharm.D., is Medication Safety Pharmacist, BJC HealthCare, St. Louis, MO, and Washington University School of Medicine, St. Louis. Mary C. Bocox, M.P.H., M.Ed., is Clinical Epidemiologist, BJC HealthCare. Elizabeth Pratt, D.N.P., RN, ACNS-BC, is Research Scientist, Nurse Specialist, Barnes-Jewish Hospital, St. Louis. Christine M. Hoehner, Ph.D., M.S.P.H., is Epidemiologist Supervisor, Quality Analytics, BJC HealthCare. John E. Krettek, M.D., Ph.D., is Vice President, Clinical Improvement, BJC HealthCare. Wm. Claiborne Dunagan, M.D., M.S., is Professor of Medicine, Washington University School of Medicine, and Senior Vice President and Chief Clinical Officer, BJC HealthCare.
authors.forename: Wm Claiborne
authors.initials: WC
authors.lastname: Dunagan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D001786:Blood Glucose; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000009:adverse effects; D007297:Inpatients; D007318:Inservice Training; D015596:Nutrition Assessment; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D001786:Blood Glucose; D007004:Hypoglycemic Agents