Hypoglycemic events can be life-threatening, especially for patients with diabetes. Severe hypoglycemia is associated with increased morbidity, length of stay, and mortality. As we mentioned in part 1 of this series,  over 200,000 patients die unnecessarily in US hospitals each year, and the Patient Safety Movement mission is to eliminate these deaths by 2020. While looking to improve prevention of severe hypoglycemia, we want to explain the performance gap and what it will take for hospitals to be able to close this gap.

As reported in Endocrine Practice, in a 2009 survey of 575 hospitals, 5.7% of all point-of-care blood glucose tests were prevalent in hypoglycemia (<70 mg/dL). Severe hypoglycemia, or a low blood glucose level (<40 mg/dL) that requires the assistance of another person for recovery can be avoided by proper management of mild hypoglycemia.

According to the Journal of Hospital Medicine, contributing factors which can lead to the development of hypoglycemia are as follows:

• Excessive insulin dose
• Inappropriate timing of insulin or anti-diabetes therapy
• Unaddressed antecedent hypoglycemia or changes in the nutritional regimen
• Creatinine clearance changes, or steroid dose
• Failure of blood glucose monitoring
• Lack of communication among physicians, pharmacists and nurses

In order to close the performance gap, hospitals and healthcare systems will have to commit to taking action. This action requires specific leadership, practice, and technology plans to create a decision making model used to predict and prevent severe hypoglycemia episodes.

In part 3 of this series, we will explain each strategy used to improve overall patient safety and outcomes.