Maintaining Glucose Targets Through the Thanksgiving Holiday
Thanksgiving is a time for celebration with family and food, but celebrating the holiday from a hospital bed is never quite as enjoyable. For those with diabetes and hyperglycemia, the holiday can either be riddled with rules to ruin the day or a free-for-all that leads to extremely high blood glucose levels. As healthcare providers, we want this time to be as special as possible for our patients. Utilizing our knowledge and tools for hyperglycemia management, we can afford to loosen the reigns on strict carbohydrate diets for many of our patients without losing sight of our targets. read more…
November is National Diabetes Month. This year, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, is celebrating the month by promoting health after gestational diabetes.
Gestational diabetes is a type of diabetes that develops during pregnancy. Up to one in every 10 pregnancies in the United States is affected by gestational diabetes, and it can pose significant health complications for both the mother and baby. 1
The International Federation of Gynecology and Obstetrics (FIGO) has even recommended that hyperglycemia/ gestational diabetes be considered a global health priority. Hyperglycemia and gestational diabetes are the leading cause of maternal mortality, results in a higher incidence of maternal morbidity and leads to long-term consequences for both the mother and the child. 2 read more…
As highlighted in our last blog, the need to improve our glycemic management practices within the inpatient setting is clear. It’s better for both the patient and hospital, but the challenge comes with implementing quality improvement initiatives. Throughout the EndoTool User Group Meeting, five elements to drive adoption were identified as the keys to success in your glycemic management optimization initiatives: data, champions, education, standardization and review of processes.
The first step to any quality improvement project is data. As Dr. Fogel, Medical Director of OR Services at the Carilion Clinic, stated, “if you don’t know where you are, you don’t know where to go, and you don’t know how to get there.” Hospitals need to track their performance on blood glucoses in target range, time to achieve target glucose range and rates of hypoglycemia, among other glucometrics.
It also was highly encouraged to regularly publicize this data with everyone on the staff to encourage positive care practices, such as timeliness of glucose checks. As Dr. Burgess, Founder and Inventor of EndoTool, pointed out, 80% of low blood glucose readings occur when the blood glucose was checked more than five minutes late. To make the metrics more meaningful to staff, he suggested that hospitals start tracking the patient days between hypoglycemic events. For example, a drop of hypoglycemia from .9% of blood glucose readings to .3% of blood glucose readings may not appear to be so significant to some. However, if it is presented as a drop from one hypoglycemic event every 111 patient days to 1 hypoglycemic event every 360 patient days, that is easily understandable to everyone and becomes more patient-centric.
With the data to know how you are performing and what needs to be done, the only way to make that achievable is to have champions supporting the initiative to improve glycemic management. With the heavy lift at hand, one champion is not enough. It needs to be a collaborative effort among a number of key roles. A glycemic optimization committee is advised to help in driving the initiative, but there also needs to be a champion for each department and unit. Also, getting nursing leadership’s support is imperative. As Dr. Fogel mentioned during his session, the one nurse who has the clout and reputation both in the hospital and unit will make a big difference in achieving successful adoption. read more…
On October 18th, Monarch hosted its annual EndoTool User Group Meeting bringing together clients from across the country to discuss inpatient glycemic management and the use of EndoTool. As Monarch President & CEO, Linda Beneze, stated at the beginning of the meeting, “we are much stronger together than apart,” and that became evident throughout the day. From new users to longtime EndoTool advocates, all took part sharing strategies, best practices, and common challenges. While there were many takeaways from the meeting, there is one that summarizes it best—quality improvement is hard but needed.
Although the industry has made significant advances in glycemic management, there is hope with increased attention being placed on glucose metrics, the opportunity to improve glycemic management continues to be crucial. Hyperglycemia remains pervasive and hypoglycemia episodes occur far too often, negatively affecting outcomes of hospitalized patients. read more…
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…