The challenge of controlling hyperglycemia and hypoglycemia in hospitalized patients drives cost increase, length of stay, morbidity and mortality. Between 10% of patients on antihyperglycemic agents suffer at least one hypoglycemic event during hospitalization, adding 31% to the overall cost of care. One cause relates to poor coordination of meal delivery and insulin administration. After internal data collection and analysis, the average time between point of care glucose testing (POCT) and insulin administration was 60 minutes. In January 2018, the overall percentage of severe hypoglycemic events (defined as <50 mg/dL) reached 9.1%. A pilot project started at the Medicine-Oncology units in March 2018 to improve coordination between POCT, meal tray delivery and insulin administration. Expected process outcomes were: effective communication between Dietary and Nursing when meal is ordered on-demand, POCT within 30 minutes of meal order and insulin administration within 15 minutes before tray delivery. Also, a branded visual cue was developed as “Insulin tents,” placed on the meal tray, encouraging patients to alert Nursing if medication was needed. Timely insulin coverage was operationalized as within 15 minutes of the first bite due to pharmacokinetics of rapid acting insulin. Our study included adults (≥18 years) admitted to the Medicine-Oncology unit who presented with hyperglycemia. Post intervention POCT data was collected March 2018 to November 2018 and compared to analogous data prior intervention (October 2016 to February 2018). We observed a reduction of hypoglycemic events, from 4.7% pre-intervention to 2.2% post intervention, and 3 months with 0 hypoglycemic events. POCT after patient’s meal order call was successful 52% of the time, and the POCT time improved from expected goal of 30 minutes to 16.6 minutes average. We concluded that the pilot project can reduce hypoglycemic events and improve patient outcomes and costs related to care.


S. Chmelnik: None. S. Abdollahi: None. C.N. Neal: None. D.R. Cameron: None.

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