- October 31, 2017
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.
Diabetes is a Growing Problem
The prevalence of diabetes is only rising across the United States. In fact, diabetes (type 2 diabetes and type 1 diabetes) will increase by 54% to more than 54.9 million Americans between 2015 and 2030. Compounding this, fewer endocrinologists are working in the hospital setting to care for these patients. As Monarch’s EVP and Chief Clinical Officer, Laurel Fuqua, noted in her presentation, the trends are not in hospitals’ favor and current practices are not necessarily the best practices. “It’s time to tame the wild west.”
Today, only a fraction of patients are meeting glycemic targets; more than 15% have hypoglycemic episodes during their stay, and between 60%- 70% of insulin regimens still utilize sliding scale only, even though there is documented evidence that basal-bolus insulin therapy is far superior for non-critical care patients. There is a large gap between current practices and optimal practices, and hospitals should care because poor glucose control is a quality of care issue, a patient safety issue, and a cost issue.
What’s Needed to Improve Glucose Control and Patient Outcomes
Hospitals need a successful glycemic control program utilizing clinical decision software support for precise insulin dosing. They need to give the right type of insulin, in the right amount, at the right time, to meet the insulin needs of patients, and to make this happen, there needs to be a clinical and administrative champion to tackle implementation and adoption.
How to be a Champion for Glycemic Control
Healthcare Corporation of America’s (HCA) Dr. Thomas Garthwaite and Dr. Wendy Gay are prime examples of the type of champions needed to drive change. During the meeting, the two discussed their glucose optimization program, including both intravenous (IV) and subcutaneous (SubQ) insulin delivery, across the system’s 177 hospitals. Comparing their journey to a long, winding road, Dr. Garthwaite and Dr. Gay noted that implementing a glucose program is not an easy task. It requires a cultural shift to change habits, address workflow, and continually educate staff. But as Dr. Gay noted, it’s a “huge problem and opportunity, that is worth the time and effort.”
In their initial roll out of EndoTool, they’ve found that they have the potential to avoid 6,232 low glucose episodes. Overall, this is a 94% reduction is severe low glucoses. And in their preliminary data, they found they could potentially reduce the cost of care by $3,380 per patient due to decreased length of stay.
HCA, along with our other presenters, had a number of key learnings and advice from their implementation and ongoing management to help champion glycemic control:
Start with Your Data
Following the HCA presentation, many attendees discussed how they have helped to bring on an IV insulin dosing program but have had trouble persuading upper management to embrace a change in approach to the basal bolus subcutaneous insulin dosing model recommended by the American Diabetes Association (ADA). The solution for HCA was data. The first step to addressing glycemic control at any organization is to collect data about current performance. Organizations need to know their glucose and patient outcomes measures and set a benchmark. During a breakout panel, Dr. Maresa Glass from Tampa General Hospital and Linda Currie from VCU Health, discussed how data can be a powerful tool for adoption. Both recounted how resistance goes away when staff and administration see their own data and the impact glycemic control can have on patient care.
The data tends to speak for itself, something that was evident in a presentation by Dr. Sandra Hardee from Vidant Health. In a published study conducted at six community hospitals, they found when using EndoTool IV, there were zero hypoglycemic episodes among DKA patients. In comparison, there were four hypoglycemic episodes using paper protocol. Further, the software program simplified insulin dosing and improved the adherence to dosing recommendations, so that there was 100% compliance as compared to only 37% compliance when using paper protocol.
Establish a Governing Board
Another key step to making glycemic control a priority at your organization is to establish a multi-disciplinary glycemic steering committee. With multiple stakeholders engaged, organizations can move the needle in establishing new policies and making changes. At Tampa General Hospital, Dr. Maresa Glass says they hold a glycemic management meeting with the various stakeholders at least quarterly to review the data and care practices.
Plan Your EMR Integration Up Front
Santa Rosa Consulting’s Ann Keillor conveyed the importance of EndoTool EMR integration. Today, 75% of clinicians’ time is spent in the EMR. By integrating EndoTool with your EMR, there are less clicks, improving the work flow for nursing staff. And with improved work flow, there is less resistance from staff and more time to spend on direct patient care.
Persistence and Measurement of Your Progress
The final key learning was that persistence pays off. Those that have been successful in making glucose control a priority at their organization advise adding it as a topic to an agenda at regularly scheduled meetings about patient and medication safety. They also work to regularly attend grand rounds to educate residents and different specialties about glucose management and constantly evaluate and promote their glucose numbers to celebrate successes and identify opportunities for improvement. The importance of training was also highlighted as successful change agents learned to never stop training and educating end users. To enhance training, attendees suggested incorporating training loops in lounges across the various units, adding tip cards to the medical carts, and establishing an ongoing effort to meet with every new resident or staff member that comes on board.
We want to thank all presenters and all our attendees for joining us and making our first event a great success. More importantly, we want to thank all users for being the champions to advance glucose management at their institutions. While barriers may stand in the way, glucose control matters. The time is now to be a change agent and join these individuals in improving inpatient glycemic management.