Using a Clinical Surveillance System to Detect Drug‐Associated Hypoglycemia in Nursing Home Residents

Abstract

Background/Objectives Hypoglycemia is a common adverse drug event (ADE) frequently associated with temporary harm in the nursing home (NH) setting. Reports from the Office of the Inspector General and the U.S. Department of Health and Human Services recommend the need for increased surveillance of drug-associated hypoglycemia events. The objective of this study was to test if a clinical surveillance system could be used to detect drug-associated hypoglycemia events and determine their incidence in NH residents Design Retrospective cohort Setting Four NHs in Western Pennsylvania Participants Computer-generated alerts detecting potential drug-associated hypoglycemia in residents with glucose ≤ 70 mg/dL and ordered a medication(s) associated with hypoglycemia over a 6-month period were included. Measurements Descriptive statistics were used to summarize all variables, including the frequency and distribution of alert type by glucose threshold. Analyses were conducted per numbers of alerts and per distinct residents. The frequency of medications associated with the alerts was determined. Additional calculations included the time to drug-associated hypoglycemic event alert from date of admission and frequency of events associated with post-acute/short-stay (≤ 35 days) admissions. Results Total of 772 alerts involving 141 unique residents were detected. Ninety (63.8%) residents had a glucose ≤ 55 mg/dL, and 42 (29.8%) had a glucose ≤ 40 mg/dL alert. Insulin orders were associated with 762 (98.7%) alerts. Overall incidence of drug-associated hypoglycemia events was 9.5 per 1000 resident-days. Conclusion Hypoglycemia can be detected using a clinical surveillance system. Our evaluation found a high incidence of drug-associated hypoglycemia in a general NH population. Future studies are needed to determine the potential benefits of use of a surveillance system in real-time detection and management of hypoglycemia in the NH.

Transforming the Medication Regimen Review Process Using Telemedicine to Prevent Adverse Events

“…CPs also received clinical decision support (CDS) alerts that were formulated within an electronic health record (EHR)‐agnostic platform (TheraDoc®, Premier, Inc., Charlotte, NC). TheraDoc® is a clinical surveillance system that contains many predeveloped alerts and allows for customizable alerts, “EZ alerts,” to be developed by local users 21‐23 . Alerts were developed to detect potentially inappropriate prescribing (defined by CMS as excessive dose, lack of monitoring, and therapeutic duplication) and recommendations in the Office of Inspector General Report 4,20 .…”

“They Don’t Trust Us”: The Influence of Perceptions of Inadequate Nursing Home Care on Emergency Department Transfers and the Potential Role for Telehealth

“…Telehealth has been a useful intervention to optimize health care in a number of SNF environments. Surveillance of dangerous lab values and automated clinical decision support for NH residents have used telehealth to trigger automated alerts in electronic health records (Culley, Perera, Marcum, Kane-Gill, & Handler, 2015;Kane-Gill, Achanta, Kellum, & Handler, 2016;Kane-Gill et al, 2017). Others have successfully used off-hour telemedicine consultation as opposed to on-call NH providers to reduce preventable NH to ED transfers (Grabowski & O'Malley, 2014).…”

A systems approach to identify factors influencing prevention, detection and management of adverse drug events in nursing homes

“…Data from a recent study showed that insulin caused 98.7% of hypoglycemia alerts in four NHs [68]. The results of these studies help to compare our study results since we investigated ADEs caused by all the above medications.…”

“…In Pennsylvania also, a recent retrospective cohort study reported an incidence of drug-induced hypoglycemia of 12.8%, and insulin was associated with the majority (98.7%) of the cases. [68]. An Italian study found a fall incidence rate of 1.38 per 100 resident-months and 48.1% of these falls resulted in injuries.…”

“…These medications can cause common ADEs including bleeding, thromboembolic events, hypoglycemia, falls, constipation and acute kidney injury among NH residents. Fifteen ADErelated studies reported one or more of the following six medications classes to be most frequently associated with ADEs: Psychotropic drugs (antipsychotics, antidepressants, anxiolytics, and hypnotics) [8,15,27,29,30,33,38,52,[62][63][64][65][66][67][68] , cardiovascular agents (diuretics, ACEIs and digoxin) [27, 29-31, 33, 34, 38, 52, 62, 65, 66, 68], opioid analgesics [15,27,30,34,41,66], anticoagulants (warfarin) [8,27,34,37,38,52,66], antibiotics [8,27,30] [31,63,69] and antidiabetics (insulin) [30,38,66,68]. The most common ADE-related medications and ADEs in the above studies are the same ones listed in ADE-trigger tool, which was used in our study.…”