Background: Hypoglycemia is a known cause of morbidity and mortality in the hospital setting. Nursing initiated interventions to reduce hypoglycemia rates have rarely been reported.
Methods: At our institution, hypoglycemia rate is defined as the percentage of patients with diabetes mellitus (DM) with one or more blood glucose (BG) < 70mg/dl after 24 hours of admission. Nursing units are given monthly hypoglycemia rates, retrospectively. An electronic hypoglycemia tracker tool was developed for hypoglycemia monitoring. This tool prompted nursing staff on the Respiratory Care Unit (RCU) to assess for causes of hypoglycemia. This study was a unit based quality improvement project.
Results: RCU’s baseline monthly hypoglycemia rates before intervention were: 23%, 38%, and 25% in January-March 2019, respectively. Hypoglycemia tracker results after 1 month of use demonstrated that > 50% of hypoglycemia occurrences were preceded by BG < 100mg/dl before becoming overtly hypoglycemic. Staff nurses accessed real-time data using the inpatient diabetes dashboard, beginning in April 2018, to assess BG trends on RCU patients currently admitted. Patients deemed at risk for hypoglycemia had the provider notified to intervene with reduced insulin dosage or another intervention if appropriate. Three months after intervention, monthly hypoglycemia rates decreased to 0%, 4% and 7% in April- June 2019, respectively. The RCU has been able to sustain improvement with an average hypoglycemia rate April-December 2019 of 9%.
Conclusion: Causes of hypoglycemia in the hospital setting need to be assessed in order to determine successful prevention strategies. Tools, like hypoglycemia tracker tool, has helped units assess the causes of hypoglycemia so that some events can be prevented. Traditionally providers are tasked with managing DM in the hospital. This quality improvement project showed that nurses can have an impact on preventing hypoglycemia.
A. Hasse: None. R. Schulman: None. T. Calder: None.
