Multifaceted approach to reducing occurrence of severe hypoglycemia in a large healthcare system

Milligan, Paul E.; Bocox, Mary C.; Pratt, Elizabeth; Hoehner, Christine M.; Krettek, John; Dunagan, W. Claiborne

doi:10.2146/ajhp150077

Cited by 19 publications

(8 citation statements)

References 15 publications

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“…Of the five time series studies, Coleman et al 18 identified a 0.41% decrease in missed doses of medications other than antibiotics (p=0.007); however, it was part of four concurrent interventions to reduce missed and delayed medication doses, and thus, the specific impact of the dashboard was unclear. Similarly, Milligan et al 41 reported a reduction in hypoglycaemic rates, Rioux et al 28 reported a decrease in surgical site infections over a 6-year period after dashboard implementation, and Mackie et al 35 reported a reduction in hospital-acquired pressure ulcers; however, in each case, the dashboard was one aspect of a broader campaign to reduce the respective patient safety events. Other studies, including Bakos, Chandraharan, Collier, Conway, Hebert, Hendrickson and Hyman, 15 17 22 24 25 30 37 reported a subjective reduction in patient safety events, but did not describe a statistical analysis.…”

Section: Resultsmentioning

confidence: 99%

Dashboards for visual display of patient safety data: a systematic review

Murphy

Savoy

Satterly

et al. 2021

BMJ Health Care Inform

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BackgroundMethods to visualise patient safety data can support effective monitoring of safety events and discovery of trends. While quality dashboards are common, use and impact of dashboards to visualise patient safety event data remains poorly understood.ObjectivesTo understand development, use and direct or indirect impacts of patient safety dashboards.MethodsWe conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, EMBASE and CINAHL for publications between 1 January 1950 and 30 August 2018 involving use of dashboards to display data related to safety targets defined by the Agency for Healthcare Research and Quality’s Patient Safety Net. Two reviewers independently reviewed search results for inclusion in analysis and resolved disagreements by consensus. We collected data on development, use and impact via standardised data collection forms and analysed data using descriptive statistics.ResultsLiterature search identified 4624 results which were narrowed to 33 publications after applying inclusion and exclusion criteria and consensus across reviewers. Publications included only time series and case study designs and were inpatient focused and emergency department focused. Information on direct impact of dashboards was limited, and only four studies included informatics or human factors principles in development or postimplementation evaluation.DiscussionUse of patient-safety dashboards has grown over the past 15 years, but impact remains poorly understood. Dashboard design processes rarely use informatics or human factors principles to ensure that the available content and navigation assists task completion, communication or decision making.ConclusionDesign and usability evaluation of patient safety dashboards should incorporate informatics and human factors principles. Future assessments should also rigorously explore their potential to support patient safety monitoring including direct or indirect impact on patient safety.

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Section: Resultsmentioning

confidence: 99%

Dashboards for visual display of patient safety data: a systematic review

Murphy

Savoy

Satterly

et al. 2021

BMJ Health Care Inform

View full text Add to dashboard Cite

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“…Studies of "bundled" preventative therapies including proactive surveillance of glycemic outliers and an interdisciplinary data-driven approach to glycemic management showed that hypoglycemic episodes in the hospital could be prevented. Compared with baseline, two such studies found that hypoglycemic events fell by 56% to 80% (49,50). The Joint Commission recommends that all hypoglycemic episodes be evaluated for a root cause and the episodes be aggregated and reviewed to address systemic issues.…”

Section: Preventionmentioning

confidence: 99%

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

2017

Diabetes Care

157

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The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

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“…Studies of "bundled" preventative therapies including proactive surveillance of glycemic outliers and an interdisciplinary data-driven approach to glycemic management showed that hypoglycemic episodes in the hospital could be prevented. Compared with baseline, two such studies found that hypoglycemic events fell by 56% to 80% (38,39). The Joint Commission recommends that all hypoglycemic episodes be evaluated for a root cause and the episodes be aggregated and reviewed to address systemic issues.…”

Section: Preventionmentioning

confidence: 99%

14. Diabetes Care in the Hospital

2016

Diabetes Care

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Recommendations c Perform an A1C for all patients with diabetes or hyperglycemia admitted to the hospital if not performed in the prior 3 months. B c Insulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold $180 mg/dL (10.0 mmol/L). Once insulin therapy is started, a target glucose range of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for the majority of critically ill patients A and noncritically ill patients. C c More stringent goals, such as ,140 mg/dL (,7.8 mmol/L), may be appropriate for selected patients, as long as this can be achieved without significant hypoglycemia. C c Intravenous insulin infusions should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin infusion rate based on glycemic fluctuations and insulin dose. E c Basal insulin or a basal plus bolus correction insulin regimen is the preferred treatment for noncritically ill patients with poor oral intake or those who are taking nothing by mouth. An insulin regimen with basal, nutritional, and correction components is the preferred treatment for noncritically ill hospitalized patients with good nutritional intake. A c Sole use of sliding scale insulin in the inpatient hospital setting is strongly discouraged. A c A hypoglycemia management protocol should be adopted and implemented by each hospital or hospital system. A plan for preventing and treating hypoglycemia should be established for each patient. Episodes of hypoglycemia in the hospital should be documented in the medical record and tracked. E c The treatment regimen should be reviewed and changed as necessary to prevent further hypoglycemia when a blood glucose value is ,70 mg/dL (3.9 mmol/L). C c There should be a structured discharge plan tailored to the individual patient with diabetes. B HOSPITAL CARE DELIVERY STANDARDS High-quality hospital care for diabetes requires both hospital care delivery standards, often assured by structured order sets, and quality assurance standards for process improvement. "Best practice" protocols, reviews, and guidelines (2) are inconsistently implemented within hospitals. To correct this, hospitals have established protocols for structured patient care and structured order sets, which include computerized physician order entry (CPOE). Considerations on Admission Initial orders should state the type of diabetes (i.e., type 1 or type 2 diabetes) or no previous history of diabetes. Because inpatient insulin use (5) and discharge orders (6) can be more effective if based on an A1C level on admission (7), perform an A1C test on all patients with diabetes or hyperglycemia admitted to the hospital if the Suggested citation: American Diabetes Association. Diabetes care in the hospital. Sec. 14. In Standards of Medical Care in Diabetesd2017.

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Multifaceted approach to reducing occurrence of severe hypoglycemia in a large healthcare system

Abstract: A multifaceted, evidence-based, data-driven approach enabled a large healthcare system to markedly reduce the frequency of severe hypoglycemia events.

Cited by 19 publications

References 15 publications

Dashboards for visual display of patient safety data: a systematic review

Dashboards for visual display of patient safety data: a systematic review

14. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes—2018

14. Diabetes Care in the Hospital

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