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.
“It’s only when you drop yesterday’s assumptions that you can glimpse tomorrow’s patterns and possibility. To see deeper, unsee first.” – Umair Haq
Clinical inertia is a term that has been used to define the resistance to a new therapeutic treatment. Across healthcare, we see clinical inertia often, but perhaps the best example is the treatment of hyperglycemia. The way we have managed hyperglycemia, with paper protocols and sliding-scale insulin, is no longer the best practice, yet it remains pervasive.
The Problem with Sliding-Scale Insulin
For more than 80 years, hospitals have been using sliding-scale insulin to manage hyperglycemia in non-critical care units. In 1934, Elliot Joslin created the first iteration of sliding-scale insulin known as “rainbow coverage.” The original sliding scale would recommend specific amounts of regular insulin after testing a patient’s urine for glucose based on its color. While we have moved away from the rainbow coverage testing, the sliding-scale method has not dramatically changed. Our method of testing glucose and the type of insulin administered has been improved to better support patient care, but the practice remains reactive. We continue to treat hyperglycemia after it has occurred.
Numerous studies, dating as far back as even the 1970s, have shown that using sliding-scale insulin is an ineffective way to manage blood glucose. Because this method is essentially chasing rather than preventing hyperglycemia, a “roller coaster” effect with dramatic blood glucose variability is often seen among hospitalized patients, and as a result, patients are more likely to experience adverse patient outcomes and longer length of stay.
“Year’s end is neither an end nor a beginning but a going on” – Hal Borland
This past year proved to be an exciting time in the advancement of diabetes care. New technology and new research are on the forefront of improving aspects of living with and even preventing diabetes. Take for instance the development of the artificial pancreas, the holy grail of diabetes innovation, which first came to market this past year.
While important advancements have been made, there is still much to accomplish and much more adoption that needs to occur, particularly in the inpatient setting. With the new year, we have an opportunity to look at what lies ahead as we continue to keep “going on” to advance glycemic management.
Recently, I attended Becker’s Review Healthcare IT and Finance conference in Chicago. The event drew hundreds of administrators and providers from around the country to address the substantial challenge in front of Healthcare CIO’s and CFO’s: proving the value of healthcare services our industry provides.
Since the introduction of the Affordable Care Act, the healthcare industry’s focus has transitioned away from fee-for-service treatment of acute illness, to instead recognizing that managing chronic illnesses, like diabetes, provides better health outcomes for individual patients and the community at large.
The conference challenged me to ask, how does Monarch Medical Technologies, specifically our EndoTool® Glucose Management System, contribute to better health outcomes for overall patient populations? What value do we add?
Imagine if a patient’s blood glucose was still determined through urine strip testing. Although it was once seen as a best practice, it would now be laughable and likely thought of as downright poor patient care.
As medicine evolves, the best practices and guidelines must continuously be reviewed and updated to account for the current evidence-based and state-of-the-art knowledge. In the diabetes community, this is exactly what occurred with the new consensus statement published in the journal Diabetes Care, “Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes.” The statement recognizes glycemic management outcomes other than just hemoglobin A1c (HbA1c) and clearly defines measurements.
National Diabetes Month is a recognition that began 35 years ago, but perhaps is needed now more than ever before.
According to the Centers for Disease Control and Prevention (CDC), 30.3 million people have diabetes in the U.S. That amounts to roughly one in 10 Americans, and it’s only growing in prevalence. It is estimated that by 2050, this figure will rise to one in three.
This year’s National Diabetes Month should not just be an acknowledgement, but a rather a call to action. It should serve as a reminder that more has to be done to not only prevent the disease, but also to better manage all aspects of the disease across the care spectrum.
During National Diabetes Month, the week of November 5-11 provides an opportunity to recognize a special group of healthcare professionals, diabetes educators. This week, also known as National Diabetes Education Week, is meant to be a time to celebrate all that diabetes educators do to help those affected by diabetes.
At Monarch, we’ve had the opportunity to work with many diabetes educators. In fact, roughly, 25 to 30 percent of all diabetes educators work in the hospital setting. Diabetes mellitus is the second most common diagnosis for those discharged from hospitals among adults age 18 and older, and patients with diabetes are frequently hospitalized, for treatment of conditions other than diabetes.
Diabetes educators play an integral role in managing diabetes in the inpatient setting. They are tasked with delivering comprehensive staff and patient diabetes education, monitoring of outcome measurements, establishing evidence-based hypoglycemia and hyperglycemia management order sets and protocols, and developing a plan of care that facilitates a smooth transition across the care settings. They not only serve as a key member of the interdisciplinary team that help to manage a patient’s care throughout the continuum, but they also can impact change for the overall glycemic management processes and programs.
In a new DiabetesMine blog post, “Convincing Hospitals That Glucose Management Matters,” author Dan Fleshler questions why some hospitals are still using “old-fashioned, time-consuming, error-prone approach to regulating blood glucose.” The blog, which features Monarch Medical Technologies, addresses one of the biggest challenges in the industry, convincing hospital administration and providers that glucose management needs to become a priority.
The blog, which begins, “patients’ blood glucose (BG) levels in many American hospitals run dangerously high, but hospitals aren’t doing nearly enough to address the problem,” highlights the dangers of unsafe blood glucose management and lack of adoption of new technology and protocols to advance diabetes care. According to the article, between 70% and 80% of patients with diabetes experience hyperglycemia when hospitalized for critical illnesses or have cardiac surgery, and roughly 30% of all patients receiving care in hospitals experience high blood sugars (>180 mg/dL). Yet, only about 10% of American hospitals are using e-glycemic management solutions to determine patient’s insulin doses. As the author notes, “hospital diabetes management has the potential for a seismic shift — if they choose to adopt these newer innovations.”
Highlights from the EndoTool User Group Meeting: Transforming Inpatient Glucose Control is Mission-Critical for Hospitals and Patients
On October 19th, Monarch Medical Technologies hosted its first annual EndoTool® User Group Meeting in Charlotte, NC. Joined by clients across the country, the group explored ways to better utilize EndoTool IV and SubQ across their systems. While many left with pages of notes on how to improve their processes and education at their organizations, one overarching theme can summarize what was evident at the event—glucose management must be a priority at hospitals and it requires a champion at each organization to lead the way.