- Chris Santry, MSN, RN, CCRN
- June 14, 2018
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.
Evaluation #2: Utilization
Compare the utilization of EndoTool protocols to other insulin dosing protocols in your system. Is EndoTool being used 100% of the time for IV insulin dosing? Is a routine basal-bolus insulin therapy (BBIT) protocol being initiated for all appropriate patients on EndoTool SubQ? Is there a group of providers who are reluctant to let go of the traditional sliding-scale insulin protocol? Asking these questions and collecting data can provide valuable insight to your assessment of early adoption. In addition, the answers may identify misconceptions in best practice, poor understanding of the process, or a need to modify or clarify the process further.
Evaluation #3: Dosage Deviations and Deleted Readings
EndoTool Analytics provides an easy to access record of dosage deviations from protocol and deleted blood glucose entries. The dashboard summary provides a snapshot of the number and percentage of dosage deviations and deleted readings in a given period. You can drill down the data by facility, unit, date range, and application, allowing you to generate reports to reveal further details. Are nurses frequently deviating from EndoTool recommendations, and if so, are you able to identify a trend among staff, or in the reasons for deviation? Are users frequently deleting blood glucose readings from the glucose history? Trending the number of and reasons for dosage deviations and deleted readings can provide a lot of information about the pain points and challenges nurses or providers are facing in the process or workflow. These challenges can frequently be addressed through education or slight revision of the process, resulting in fewer deviations and deletions, and therefore better acceptance and adoption, over time.
Evaluation #4: Hypo Readings and Clinicians Late
Reduction of, and ultimately elimination of, both mild and severe hypoglycemia is a common goal among many health systems adopting EndoTool. Hypoglycemia rates should be carefully monitored, and hypoglycemic events should be investigated for root causes. Again, EndoTool Analytics provides an easy access snapshot of hypo readings right on your dashboard summary. One common issue that can lead to higher hypoglycemia rates is late blood glucose checks, which is why EndoTool Analytics also provides a Clinicians Late report. If you notice a high rate of late blood glucose readings, its important to evaluate the situations causing them. Can you make improvements to process and workflow, or develop an innovative new process, to ensure blood glucose checks are completed and entered in a timely manner for optimal dosage recommendations? By mitigating common reasons for late entries, you may realize a benefit of a concurrent reduction in hypoglycemia as well.
Evaluation #5: Long-Term Assessment, Maintenance, and Improvement
If you haven’t done so already, take some time to evaluate your health system’s commitment to long-term success in improving glycemic management. Start a glycemic optimization committee to provide continuous assessment of glycemic metrics, maintenance of evidence-based policies and protocols, and nurse-driven performance improvement initiatives. If you already have a committee in place, use this time to assess the effectiveness of the team. Are current initiatives in line with the team’s mission and goals? Has the team incorporated EndoTool data reporting and evaluation into its agenda? Do you have engagement from the top down, and bottom up, to allow input and a voice from multiple perspectives? Ensuring a long-term plan is in place will help transfer your early successes in clinical adoption into sustainable improvements in patient safety and glycemic related outcomes.
About the Author: Chris Santry, MSN, RN, CCRN is a Clinical Services Specialist at Monarch. In his role, he is responsible for supporting clients in the implementation and ongoing management of the EndoTool Glucose Management System. Chris works with clients to understand their existing glycemic management processes and protocols and address any gaps that may exist to ensure a successful implementation. Once in use, he continues to serve as a resource providing ongoing analysis and training to optimize EndoTool. Prior to Monarch, Chris was a critical care nurse at Gwinnett Medical Center and an adjunct instructor in the nursing department at Gwinnett Technical College.