Historically, diabetes care in the hospital setting has been hard to measure for many organizations. When it comes to glucose metrics, many keep track of their hypoglycemia as “never events,” but measurement of hyperglycemia has not been as much of a priority. This, however, may be changing for hospitals across the country. Reporting glucose metrics, as part of improved medication safety, are the next quality measures that are expected to be adopted.
Last year, the Centers for Medicare & Medicaid Services (CMS) began a Medication Measures Special Innovation Project to develop new quality measures for medications that affect patient safety for Medicare patients. The project has since resulted in the recommendation of 8 National Quality Forum (NQF)-endorsed measures for the ambulatory care setting, including two electronic clinical quality measures for the inpatient setting. These two electronic clinical quality measures, NQF 2362 and NQF 2363, are for hyperglycemia and severe hypoglycemia. read more…
At this year’s EndoTool User Group Meeting, taking place October 18th in Charlotte, NC, Caroline Isbey, RN, MSN, CDE, Associate Director Accreditation and Disease-Specific Care Certification at the Joint Commission, will be presenting on the Advanced Inpatient Diabetes Care Certification.
In a Q&A with Caroline, we discuss the certification program and what attendees can plan to learn more about during her presentation at the annual user meeting.
Q: How would you describe your role with the Joint Commission?
A: I support organizations that make the decision to pursue the certification and serve as a resource for these organizations while they prepare for Inpatient Diabetes Care certification.
Q: What is the Advanced Inpatient Diabetes Certification Program?
A: This is a comprehensive program evaluating Inpatient Diabetes Care for all patients admitted with a principle or past medical history of diabetes. The certification includes all areas where care is provided for a patient with diabetes such as the cardiac lab, emergency department, labor and delivery (if the hospital has this unit), pediatric (unless the pediatric care is provided in a free-standing pediatric hospital), critical care unit, etc. read more…
As we are entering another exciting season of football, I started thinking about how the elements of a football game are a lot like solving any major problem. The players need to generate positive forward movement to continue to move the chains to get to score. In most situations other than football, we refer to this as “moving the needle,” a term often used in conjunction with making progress on a big goal or a big problem.
Inpatient glycemic management is certainly a big problem, and given the growing diabetes epidemic, it is likely to become an even bigger problem. It is estimated that 28-40% of patients in the hospital have diabetes and that number is growing. Also, hyperglycemia can impact patients that do not have diabetes due to the stress of hospitalization.
Hospitals, their providers, nurses and patients across the country are still being impacted by substandard glycemic management. Hospitals experience increased medication errors, longer lengths of stay, readmissions that impact their bottom line. Physician and nurses experience dealing with time consuming episodes of hypoglycemia that require intervention and treatment. Finally and most importantly, patients are affected. They may experience scary symptoms of hypoglycemia, poor wound healing, increased hospital acquired infections from high blood glucoses, and ultimately more time away from their loved ones at home. read more…
Monarch’s second annual EndoTool User Group Meeting is fast approaching, providing a forum for EndoTool users to discuss new product features and trends in the industry, as well as the best practices for education and implementation. As we look forward to this year’s event and continue to discuss how we can advance inpatient glycemic management, we also want to reflect on how we got here.
In a Q&A with Dr. Patrick Burgess, MD, PhD, the founder and inventor of EndoTool, we discuss the early development of EndoTool, his experience, and the research he plans to share at this year’s User Group Meeting.
Q: How did you come up with the idea to create EndoTool?
A: While practicing nephrology at Carolinas Medical Center, I was asked to help with the glycemic control in a cardiovascular recovery unit because of the immense pressure being placed on the surgeons to reduce their sternal infection rate. I tried the published paper protocols with partial success and much angst by the nursing staff. The protocol consisted of a few decisions and mathematical calculations that took up a lot of time from the nurses’ busy schedules. We had reached only half of our goal using a paper protocol, so I proposed to the surgeons that I could control the glucose levels with a computer program that would take the math to the next level and be less work for the nursing staff. A month later we had normal glucose levels on the first morning post-op, no sternal infections, a happy staff, and an extremely low incidence of hypoglycemia. An endocrinologist looked over my shoulder and suggested we make it commercially available.
After three months of trying to practice nephrology and developing a product, I decided that I would turn all my focus and efforts into the development of EndoTool. It was a difficult decision, but not a regretted one because I have touched more patients than I could have ever seen in practicing medicine. Even though I was the inventor of EndoTool, it would be injustice to take all the accolades of it because the former CEO, Shade Mecum, software developers, John Thornley and Paul Hester, and the initial nursing staff, including Laura Santana, have contributed heavily to all aspects of the software and delivering it to hospitals for patient care. read more…
The Monarch team attended the 78th Scientific Sessions in Orlando, Florida at the end of June. The annual conference highlighted new ideas and significant advances in diabetes research, treatment, and care. While multiple sessions were covered and new studies were released, two major themes emerged at this year’s event— action to address diabetes care is now needed more than ever and the importance of personalized treatment is key.
During her Presidential Address, Jane E.B. Reusch, MD, ADA President, Medicine & Science, called for members to act. “Diabetes is out of control,” said Dr. Reusch. “We cannot accept that trajectory. We have to change that curve.”
According to Dr. Reusch, diabetes is responsible for a stroke every 2 minutes, an ischemic cardiac event every 80 seconds, kidney failure every 10 minutes, lower limb amputation every 5 minutes, and a death every 6.5 minutes. In comparison, the current opioid epidemic claims a life every 52 minutes yet receives far more attention than diabetes.
Even though the burden of diabetes is staggering, there is hope. As the conference made clear, technology will be influential in managing and addressing the needs of patients with diabetes. read more…
You’ve put in the time and the effort, and EndoTool® is now live in your hospital. Whew… Kudos!
But what’s next?
Whether you prefer to use the nursing process (ADPIE), Deming’s PDCA cycle, or another method of change management, the key to continuous improvement and sustainable success comes with evaluation of your intervention. Implementation of the EndoTool Glucose Management System is a great step toward improving glycemic management in your hospital, but the real success comes from improving patient safety and optimizing outcomes. Thus, the installation of the software should not be your end goal, but an intervention to help you achieve meaningful results.
Assessing the level of clinical adoption in your organization can be difficult. While many will be supportive, some team members may have a manifestation of uncertainty or fear during the change implementation process, resulting in a level of resistance. Others may have a slower learning curve, presenting further barriers and challenges. Since early adoption of process change can be a critical success factor in creating profound and sustainable results, it’s important to start evaluating the data early.
In addition to your usual evaluation methods, EndoTool Analytics and EndoTool Self-Service Analytics are tools which can provide clinicians and quality analysts with some of the valuable information needed to assess how EndoTool is being utilized. The dashboard summary provides a quick snapshot of utilization and patient safety data. More detailed reports can be used to drill down through available filters to identify defects in processes and challenges faced by staff.
Use these five post-implementation evaluations to identify and overcome challenges in clinical adoption in your hospital:
Evaluation #1: Process Awareness & Understanding
Interview a sample population of nurses, managers, providers, and other appropriate professionals. Are they aware of the process changes put in place to optimize the use of EndoTool? Can they participate in an educated conversation about how the system is used and how each step in the process can impact patient safety? Evaluating process awareness and understanding creates a first glimpse into any weaknesses in the process, as well as gaps in communication or knowledge. Consider using posters in common spaces, email blasts, and team huddles to enhance awareness and understanding of the process change. read more…
The month of May is host to several healthcare recognitions; there’s National Nurses Week, National Hospital Week, Stroke Awareness Month, and Mental Health Awareness Month. But, among all these recognitions, there is one that doesn’t get nearly as much attention: National Critical Care Awareness and Recognition Month (NCCARM).
NCCARM honors the intensive care unit (ICU) teams that make a difference every day caring for patients and families in what is often their most vulnerable moments in life. Nearly 80% of all Americans will suffer, or know someone who is suffering, from a life-threatening illness or injury, requiring the support of providers in the ICU. These patients, who may be battling an acute illness or complexities from a chronic illness, are in a state of stress, which in turn results in an increase in insulin resistance and greater likelihood for hyperglycemia. With high glucose levels, patients become more at risk for infection, take longer to heal, and are more prone to longer length of stay and readmissions.
This NCCARM, we are paying the attention it deserves by focusing on the best practices for insulin therapy in the critical care setting. read more…
As the founder of modern nursing, Florence Nightingale, said, “the very first requirement in a hospital is that it should do the sick no harm.” Hospitals have an obligation to deliver safe, quality care, and this obligation can only be achieved with the support of the largest group of healthcare professionals, nurses.
For more than 60 years, National Nurses Week has celebrated the integral role nurses play in moving healthcare forward. In honor of this year’s celebration, we would like to recognize our nursing partners and team members who are doing just that by inspiring, innovating and influencing each day to improve the delivery of healthcare, and particularly inpatient glycemic management.
Nurses play a central role and are often responsible for the implementation of protocols, order sets, monitoring, and education that lead to successful inpatient glycemic management. Whether a nursing leader designing the approach to treat patients with hyperglycemia or the bedside caregiver overseeing all care on a 24-hour basis and coordinating the care of patients with hyperglycemia, all nurses are pivotal to achieving best practice clinical care.
Whether in the cardiac care unit or in a general hospital medicine unit, helping patients to reach glucose control is a necessary component to delivering quality care. To advance glycemic management practices, and ultimately improve patient outcomes, hospitals must have a comprehensive inpatient glycemic control program, and for it to be successful, it must include these eight essential elements:
Support from Administration
For an initiative to gain institutional buy-in from the heads of different departments to the frontline staff, it has to have support at the top. With the appropriate support from administration, addressing and improving glycemic management becomes more achievable because all staff members understand its importance as a key goal for the entire organization.
Glycemic Management Committee
Because hyperglycemia and diabetes touch every unit within a hospital, it requires a cross-functional team with multiple clinicians, staff members, and departments all working together. To foster this collaboration and drive continual improvement efforts, a multidisciplinary steering committee is necessary. With this group, they can focus on reaching glycemic targets and can regularly report to other key medical staff committees to keep glycemic management an area of focus.
To understand how you are performing and begin the improvement process, you must first know your data. Organizations need to know their glucose and patient outcomes measures and set benchmarks. Hospitals should know how they are performing on clinically meaningful outcomes including hyperglycemia, hypoglycemia, time in normal range, HbA1c, and diabetic ketoacidosis (DKA), among others. And just collecting this data is not enough; it must be shared to inform the team and frontline workers of progress and problem areas to address.
Gap Analysis of Processes and Outcomes
Along with the data, an assessment of current processes, quality of care, and the barriers that stand in the way of making changes to the current practices will aid in determining how to approach improvement of glycemic management. With a clear understanding of what needs to be done and obstacles that may be present, organizations can then develop specific aims that are timely, measurable, and achievable. read more…
When it comes to glycemic management in the hospital setting, hyperglycemia is present in every unit. In order to standardize care, it requires a cross functional team with multiple clinicians, staff members, and departments all working together. With March being National Nutrition Month, we are focusing on one of the most important areas of collaboration, nutrition.
Understanding and monitoring a patients’ nutritional intake is a vital part of successfully managing glycemic control. Carbohydrates are the macronutrients that have the most impact on blood glucose. Because of the direct correlation between nutrition and glycemic management, medical nutrition therapy (MNT) is an integral component in maintaining glycemic control for hospitalized patients and must address special challenges related to illness, changes in medications, and erratic meal schedules.
While in the hospital, patients receive nutrition from a variety of sources, including meals, IV solutions, TPN and tube feed products, and for each patient, managing nutrition requires a significant amount of coordination. Physicians, nurse practitioners, pharmacists, and registered dietitians must work together to develop and implement the medical treatment and nutrition plan.