A real-time nursing intervention reduces dysglycemia and improves best practices in noncritically ill hospitalized patients
✍ Scribed by Hasan Shabbir; Jason Stein; David Tong; Vikas Bhalla; Alan Wang
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 480 KB
- Volume
- 5
- Category
- Article
- ISSN
- 1553-5592
- DOI
- 10.1002/jhm.590
No coin nor oath required. For personal study only.
✦ Synopsis
Abstract
BACKGROUND:
Dysglycemia is prevalent in hospitalized patients and is associated with poor clinical outcomes. Educational interventions insufficiently improve best practices in managing dysglycemia.
OBJECTIVE:
To reduce dysglycemia by improving best practices for inpatient glycemic control.
DESIGN:
Interrupted time series.
SETTING:
A community teaching hospital.
PATIENTS:
A total of 653 adult, noncritically ill, nonobstetric patients.
INTERVENTION:
A real‐time nursing intervention (RTNI). A charge nurse issued a verbal invitation to the physician to utilize the existing glycemic control order set for patients with dysglycemia.
MEASUREMENTS:
(1) Lone correctional insulin (LCI) usage; (2) potentially inappropriate oral hypoglycemic medication (PIOHM) usage; (3) patient day‐weighted mean glucose (PDWMG; ie, mean glucose for each hospital day, averaged across all hospital days); (4) the percent of patients with PDWMG >180 mg/dL; and (5) the prevalence of severe hypoglycemia.
RESULTS:
The use of LCI regimens decreased from 48% to 30% (P < 0.01) during the RTNI period and the rate of potentially inappropriate oral hypoglycemic medications (PIOHMs) usage was reduced from 29% to 13% (P < 0.01). PDWMG decreased from 166 mg/dL to 156 mg/dL (P = 0.04). After removal of the RTNI, outcome measures were not significantly different from baseline, with the exception of PIOHM use, which remained lower at 19% in the postintervention group (P = 0.04).
CONCLUSIONS:
An RTNI promoting a best‐practice glycemic control order set was successful in modestly lowering mean glucose levels and substantially reducing the use of LCI and PIOHMs. Journal of Hospital Medicine 2010;5:E15–E20. © 2010 Society of Hospital Medicine.