Background: Approximately 30% of inpatient admissions require glycemic management at our 680 bed academic hospital. The Inpatient Diabetes (DM) Program created internal glycemic goals, employed targeted strategies to meet and sustain these goals, and began participation in a national database for comparative benchmarking.
Purpose: The purpose of the Inpatient Diabetes Program is to lead evidence-based diabetes care to achieve glycemic outcomes for hospitalized patients.
Method: The DM Program uses targeted strategies to meet glycemic outcomes, including daily surveillance, real-time communication with providers, maximization of the Electronic Health Record (EHR), provision of varied educational formats, and empowerment of front line staff in decision making. Daily real-time communication occurs with the prescribing provider (e.g., resident/advanced practice provider and the attending provider regarding recurrent hypoglycemia and persistent hyperglycemia. Follow-up surveillance is completed to evaluate if there was a treatment change. Maximization of the EHR has facilitated standardization of care with the creation of order sets, reports and real-time surveillance. Staff education is provided using various platforms including focused courses, a DM share-point site, videos, and a DM newsletter.
Results/Outcomes: The rate of hyperglycemia (BG >180 mg/dL) has decreased in the previous 3 years from 25% to 20% for point of care glucose values, without an increase in hypoglycemia. The hypoglycemia rate has consistently remained at 2% with a severe hypoglycemia rate of 0.1%. Day weighted mean BGs in both critical care and non-critical care meet the national benchmark targets.
Implications for Practice: Using targeted interventions that are “active” strategies like frequent surveillance and real-time communication helps achieve inpatient glucose goals.
E.L. Thompson: None. B. Everhart: None.
