Elements working together

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.

Data
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.

Education
A major key in implementing and ensuring best practice clinical care is education. With new glycemic management initiatives comes changes in work flow, information flow and systems that require training to make sure all staff has the information they need to optimize glucose control. Once training has been implemented, it doesn’t stop there; continual education will keep glycemic management top of mind and staff engaged with best practices.

Standardization
In addition to educating staff, it’s equally important that there is a consistent approach across all inpatient care settings regarding glycemic management. Standardizing order sets, protocols, and policies will assist in the adoption and management of a glycemic control initiative.

Medical Nutrition Therapy
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.

Dosing Guidance for Each Individual Patient
Finally, insulin dosing must be patient-specific. Not every patient should receive the same dose of insulin as each individual has a different level of resistance, especially in the hospital. Based on factors such as age, weight, kidney function, use of steroids, and residual insulin, patients in the inpatient setting will have a different need of insulin to control their blood glucose, and it must be precisely determined to manage hyperglycemia, while avoiding hypoglycemia. Use of an eGMS, like EndoTool®, can help staff determine the appropriate dose with a system that models, predicts and adapts dosing to each patient’s physiology and individual response.

As the AACE and ADA consensus statement on inpatient glycemic control says, “the complexity of inpatient glycemic management necessitates a system approach that facilitates safe practices and reduces the risk for errors.” By establishing a glycemic optimization program and implementing these eight best practices, hospitals can improve glycemic control and deliver safer patient care.