Recent studies have linked severe hypoglycemic episodes with increased risk for adverse cardiovascular outcomes. The ADA guidelines recommend that hospitals implement a hypoglycemia management protocol that includes rechecking for hypoglycemia 15 minutes after each hypoglycemic episode.
Sunshine Union Hospital in China collaborated with Joslin Diabetes Center to implement an inpatient glucose management (IPGM) program. A steering committee was set up to oversee the implementation of inpatient protocols. As a quality improvement pilot to enhance patient safety, the committee focused effort on improving the rate of rechecking blood glucose within 15-30 minutes after a hypoglycemic episode (< 70mg/dL). Following the Plan-Do-Study-Act (PDSA) method, which is a four-step model that tests small changes to identify best practices, outcomes were tracked, analyzed, and communicated monthly with the nursing and medical staff.
Hypoglycemic events occurred 56.9 ± 22.1 times/month in the 1000-bed hospital. Hypoglycemic recheck frequency (15-30 minutes post a hypoglycemic event) steadily improved over the 12 month-period, from 0% in December of 2017 to over 95% in the last three months of 2018 (Figure 1). Most common reasons for missing hypo-recheck included patient refusal and busy nursing schedule.
PDSA model was helpful in improving outcomes in this IPGM pilot. Future efforts will leverage a similar approach to reduce inpatient hypoglycemia.
L. Yunxia: None. L. Yi: None. C. Li: None. Y. Zhengguo: None. K. Lau: None. D.M. Pober: None. L. Zhang: None. R.A. Gabbay: Advisory Panel; Self; HealthReveal, Hygieia, Lark, Onduo LLC. Consultant; Self; Sanofi. W.C. Hsu: Consultant; Self; Onduo LLC.