Background:
Despite published inpatient hyperglycemia treatment guidelines, most hospitals have not yet adopted them. In our hospital 50% of inpatients have diabetes, and neither uniform hypoglycemia treatment nor insulin protocol was available on the computerized electronic medical record.
Purpose:
To improve the treatment of diabetes in our hospital and receive Joint Commission Disease‐Specific Care Certification in Diabetes beginning with establishing both insulin and hypoglycemia protocols.
Description:
Under the auspices of the Diabetes subcommittee of the P & T Committee, we convened the Diabetes Summit, a team of endocrinologists, hospitalists, CDEs, PharmDs, and RDs, to codify individualized glycemic goals and treatment based on admission diagnosis, comorbidities, and specific needs and to decrease the number of hypoglycemic events. The Diabetes Summit launched a program to involve all health care providers in our hospital in the guideline‐based management of diabetic patients. Diabetic patients’ sensitivity to insulin is determined and insulin treatment started using long‐acting insulin, adding preprandial insulin, and correctional insulin as appropriate. An electronic hypoglycemic treatment protocol has been implemented to treat with oral glucose gel or tablets, IV dextrose or glucagon. No juice or food is used for hypoglycemia. Hypoglycemia events are recorded and appropriate changes ordered. Hospitalized patients receive diabetes teaching, and if they require insulin treatment as an outpatient, they are taught how to self‐administer insulin and how to use a glucose meter. On discharge patients receive a handbook (in English, Spanish, Russian, Tagalog, and Cantonese) containing information about diabetes self‐management and resource numbers including our diabetes education services. Written HbA1c results are recorded, and patients are counseled on the relationship between their result and their diabetes. All the clinical staff has been trained in groups and individually by the diabetes subcommittee, medical education, and nursing education on our new uniform diabetes treatment approach and protocols. The monthly diabetes subcommittee meetings, grand rounds, medical staff presentations, posters in every nursing unit, and individual plastic cards worn on lanyards are accomplishing uniform training in diabetes management in our hospital. Quality improvement monitoring, reporting, and corrective action began to chart the use of basal insulin. The summit will initiate electronic Diabetes Powerplans for both admission and insulin orders and will report deviations through the treating physicians’ department chair for evaluation and, as warranted, departmental and individual education.
Conclusions:
The treatment of diabetes is more uniform across our hospital, with an increase in the use of long‐acting insulin from 12% to 80%, since the initiation of our program. The use of the electronic hypoglycemia protocol as a standing order is also increasing.
Disclosures:
J. Gonzalez Martinez ‐ none; A. Myers ‐ none