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…
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.