title: Using a Clinical Surveillance System to Detect Drug-Associated Hypoglycemia in Nursing Home Residents.
abstract: OBJECTIVE
  To determine whether a clinical surveillance system could be used to detect drug-associated hypoglycemia events and determine their incidence in nursing home (NH) residents.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Four NHs in western Pennsylvania.
  
  
  METHODS
  Any resident of the four NHs who had a computer-generated alert detecting potential drug-associated hypoglycemia over a 6-month period were included.
  
  
  METHODS
  Descriptive statistics were used to summarize all variables, including the frequency and distribution of alert type according to glucose threshold. Analyses were conducted according to numbers of alerts and residents. The medications associated with the drug-associated hypoglycemia alerts were identified, and frequency of their inclusion in alerts was calculated. Additional calculations included time to drug-associated hypoglycemic event alert from date of admission and frequency of events associated with postacute, short-stay (≤35 days) admissions.
  
  
  RESULTS
  Seven hundred seventy-two alerts involving 141 residents were detected. Ninety (63.8%) residents had a glucose level of 55 mg/dL or less, and 42 (29.8%) had a glucose level of 40 mg/dL or less. Insulin orders were associated with 762 (98.7%) alerts. Overall incidence of drug-associated hypoglycemia events was 9.5 per 1,000 resident-days.
  
  
  CONCLUSIONS
  Hypoglycemia can be detected using a clinical surveillance system. This evaluation found a high incidence of drug-associated hypoglycemia in a general NH population. Future studies are needed to determine the potential benefits of use of a surveillance system in real-time detection and management of hypoglycemia in NHs.
authors.affiliation: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Culley
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.affiliation: Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Marcum
authors.affiliation: Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania.|Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Kane-Gill
authors.affiliation: Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania.|Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Handler
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010414:Pennsylvania / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: adverse drug event detection; clinical surveillance; hypoglycemia; nursing home