Per American Diabetes Association guidelines, every hospital should adopt a hypoglycemia management protocol and all episodes of hypoglycemia should be documented in the medical record and tracked. Chart audit findings at a large urban acute care hospital revealed that nurses were not always compliant with documentation and/or adherence to the hypoglycemia treatment protocol. Thus, a quality improvement (QI) project was implemented to improve documentation compliance and adherence to the treatment protocol.

A clinical decision support system (CDSS) was embedded into the electronic health record (EHR) to enable the treatment protocol to be visible to nurses at the point of care and a hypoglycemia flow sheet was implemented for documentation. Retrospective chart reviews (n=150) were conducted prior to and after implementation of the QI project to determine if the CDSS and flow sheet were associated with changes in compliance. Chart review evaluated the number of episodes were interventions were documented utilizing the required method and if the hypoglycemia treatment protocol was followed, not followed, or unclear.

The CDSS was associated with improvements in both documentation compliance, (72 to 87%) and adherence to the treatment protocol for hypoglycemia, (54 to 69%). There was a statistically significant relationship between the type of documentation utilized (pre-implementation vs. post implementation) and whether or not the treatment protocol was followed, not followed, or unclear (p=0.0003).

Incorporating a CDSS into the EHR may help nurses comply with management of hypoglycemia and its documentation. Hypoglycemia during hospitalization poses a risk to patient safety, therefore additional strategies should be explored to further improve adherence to hypoglycemia treatment protocols.


J.R. Gibbs: None. K. Berger: None. M. Falciglia: None.

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