Background:
Hyperglycemia and diabetes are common, affecting up to 30% of hospitalized adults in the United States. These conditions carry significant morbidity and mortality at a cost of $174 billion annually. Treatment in the hospital is critically important and complex. Often, the information that is required to develop the treatment plan is spread throughout the electronic medical record. To deliver timely and effective care for dysglycemic patients, we developed a visual cue called the glycemic control widget.
Purpose:
To present providers with an intuitive and concise yet comprehensive summary of clinical data that will identify patients with dysglycemia and then direct providers to the evidence‐based order set.
Description:
The glycemic control widget is a Cerner MPage based user interface that integrates data from the electronic medical record to provide all the information that is required to develop the glycemic care plan in a single location. Data include diagnosis, hemoglobin A1c, diet orders, insulin orders, point‐of‐care testing orders, insulin administered, and blood glucose values. The types of insulin are color coded and displayed as basal, nutritional, correctional, or one‐time orders. This language matches the vocabulary of the insulin order set and the associated educational materials. Blood glucose values and insulin doses are plotted on a graph. The x axis is time; data may be reviewed over a single day, for 2, 3, or 7 days. The left‐sided y axis is the blood glucose values, and the right‐sided y axis represents units of insulin. The background colors of the graph vary by range. The ideal range for blood glucose (100–180) is green. The ranges from 180 to 250 and from 70 to 100 are both on yellow backgrounds. The values above 250 or below 70 are posted in red. The results prompt providers to take action by linking to the insulin order set that features real‐time clinical decision support in the form of reference text.
Conclusions:
The glycemic control widget offers a thoroughly integrated review of clinical data with easy access to a robust evidence‐based order set so that insulin can be safely and effectively prescribed as indicated. This tool, along with the order set and educational campaign, will promote appropriate evaluation and treatment of hyperglycemia and diabetes, common conditions with significant clinical impact.
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