Insulin is a “high‐alert medication” carrying increased risk of significant harm when used in error. The complex nature of inpatient glycemic control requires a team approach. Team structure may be multidisciplinary, utilizing the skills of individuals from different disciplines to approach a problem, or interdisciplinary, integrating disciplines with collaborative communication and team goals.
To reduce glycemic medication errors via an interdisciplinary teamwork.
A task force was assembled to pursue Joint Commission certification in inpatient diabetes care. It was initially multidisciplinary (discipline‐specific goals/parameters) but later changed to interdisciplinary (collaborative communication/goals). Supported by the performance improvement department, it regularly reported to key medical staff committees as a subcommittee cochaired by an endocrinologist, hospitalist, and endocrine nurse practitioner. Occurrence reports and the Joint Commission Standards for Distinction for Inpatient Diabetes Care were used to identify defects in our processes of care. Key quality characteristics were sequentially selected for improvement: glucometrics, hypoglycemia, insulin error reporting, revision of insulin order sets, nursing education, glycemic medication safety, prescriber education, and patient education. Specific interventions and results were tracked by annotated run charts. Initially insulin errors were underreported, and glucometrics were lacking. Institutional and laboratory support was obtained for purchase of a commercial glucometer patient identification safety system and interface capable of tracking hypoglycemia. Nursing electronic documentation was modified to include hypoglycemia. A new electronic occurrence reporting system was implemented system‐wide. Total occurrence reporting increased by 23%, and the overall rate increased by 3%. Total reported insulin errors increased by 50% and coincided with implementation of multiple newly revised insulin order sets. Most were related to failure to follow the new protocols correctly. A nursing diabetes resource council was developed to help nurses with the new protocols. Endocrinology fellows were recruited to assist with hypoglycemia analysis and joined a subcommittee reviewing hypoglycemic events monthly. Tracking improved with full implementation of the glucometer–EMR interface. Trends were identified that required formulary changes and restrictions. An insulin verification sheet was developed requiring double nursing signatures for insulin infusion management. Because no single intervention appears responsible, we believe that the interdisciplinary team structure reduced our glycemic medication errors by 15% in 2 years.
Interdisciplinary teamwork is more effective than multidisciplinary teamwork when dealing with the complexity of glycemic management in the hospitalized patient.
R. Y. Meadows ‐ none; D. Volpi ‐ none; P. M. Bolton ‐ none; S. S. Andrews ‐none; N. Fabre‐LaCoste ‐ none; D. Saxton ‐ none; S. B. Deitelzweig ‐ none