FIGHTING THE LOWS: PHARMACIST-DIRECTED MITIGATION STRATEGIES TO DECREASE HYPOGLYCEMIC EVENTS IN A HOSPITAL SETTING

Background: In-hospital hypoglycemic events can lead to several adverse outcomes including, but not limited to, seizure, coma, or death. Vizient’s “Hypoglycemia in Insulin Use” metric, defined by the percentage of discharges with any blood glucose (BG) ≤ 50 mg/dL while on insulin, serves as a tool to improve patient care quality and delivery. An internal review of Vizient hypoglycemic events at our institution revealed two compounding risk factors for hypoglycemia for patients on scheduled insulin: SCr ≥ 1.3 mg/dL and BG < 100 mg/dL. Given their role and background, pharmacists are are well-positioned to identify at-risk patients for hypoglycemia and recommend appropriate insulin dose adjustments to prevent hypoglycemic events.

Purpose: The purpose of this project was to reduce the number of Vizient hypoglycemic events through pharmacist-led interventions.

Description: Two pilot studies were conducted at two different hospital sites, Emory Saint Joseph’s Hospital (08/01/2024-01/31/2025) and Emory University Hospital Midtown (03/17/25-05/09/25). Clinical pharmacists reviewed at-risk patients identified through an electronic medical record-generated report of patients on scheduled subcutaneous insulin and a BG ≤ 100 mg/dL within the prior 24 hours. Given patient volume at Emory University Hospital Midtown, patients with a serum creatinine < 1.3mg/dL were further filtered out from review. Pharmacists provided verbal or written recommendations for insulin dose reduction and/or discontinuation to providers during weekday hours (Monday-Friday, 0700-1530). After conclusion of the pilot studies, we compared the number of Vizient hypoglycemic events during the intervention period to a historical control period.

Conclusions: At Emory Saint Joseph’s Hospital, Vizient hypoglycemic events were reduced by 28 percent (33 vs. 46 events). Furthermore, 51.5% (17/33) of reported post-intervention events occurred over the weekend (Friday 3:30 pm to Monday 7:00 am), aligning with the period when clinical pharmacists were absent. At Emory Midtown Hospital, a 42.5% reduction in events was noted compared to the pre-intervention period (23 vs. 40 events). Pharmacists’ intervention successfully decreased the number of Vizient hypoglycemic events during the time frame studied.