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Glycemic Control Initiative Emory Johns Creek Hospital

Glycemic Control Initiative Emory Johns Creek Hospital. Hasan Shabbir October 11 th 2007. Clinical Background. Inpatient hyperglycemia related to morbidity and mortality Wide variation in practice, even in same specialty and group Evidence and National Guidelines present

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Glycemic Control Initiative Emory Johns Creek Hospital

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  1. Glycemic Control InitiativeEmory Johns Creek Hospital Hasan Shabbir October 11th 2007

  2. Clinical Background • Inpatient hyperglycemia related to morbidity and mortality • Wide variation in practice, even in same specialty and group • Evidence and National Guidelines present • Potential for QI Research

  3. Glycemic Control Task Force

  4. Diagnostic Journey

  5. Diagnostic Journey- Process Flow

  6. Glucometrics • Patient Day Weighted Mean Glucose • Mean <130, Mean 131-180, Mean >180 • Overall Means • Hypoglycemia Rates • % Usage of Sliding Scale Insulin Alone • % Usage of Inappropriate Oral Medications

  7. Poorly Controlled Patients

  8. Well Controlled Patients

  9. Patients Only on Sliding Scale Insulin

  10. Inappropriate Oral Medication Use

  11. Leverage Points/Interventions • Order Sets to increase appropriate medication selection/dosing, Poster to guide insulin titration • Order Set Implementation • Tracking and displaying Metrics • Nursing education series • Physician Office visits

  12. Aim Statement • The glycemic control task force is to achieve a 10% decrease in mean glucose levels for hyperglycemic floor patients, while improving the proportion of patients who are poorly controlled at EJCH by 50% through a multifaceted approach utilizing classes for nursing, order sets, reminder posters, and office visits with physicians.

  13. Plan of Action Develop Order Sets- MD’s, Pharmacists, Dietician • Conversion Protocol (Infusion to SQ Insulin) • Floor Protocol • Inappropriate Medications • Prompts for Basal and Prandial Insulin • Table for Correctional Insulin • Hypoglycemia Protocol • Guide for Nutritional Interruptions

  14. Plan of Action (cont.) • Posters for MD’s to Properly Titrate Insulin • Office Visits • Physician Lunch • Administrative Support • Meeting with Senior Administrators

  15. Insulin Titration Tables A) Basal insulin . B) Prandial Insulin titration (use either method) Method 1. Adjust total prandial Insulin dose to be 40-60% of total daily insulin dose. For Example: If Lantus dose =30units, Total prandial insulin should equal ~30units Method 2. Use Table Below

  16. Physician Signature:__________________________________ Date:__________ Time: __________ Medical Record Patient ID Page 1 of 2 September 1, 2007 Physician Signature:__________________________________ Date:__________ Time: __________ Medical Record Patient ID Page 2 of 2

  17. Rapid Cycle “Act” • Administrative Support- Success! • Posters/Flyers- Finalized and Posted • Physician Lunch- Only one MD present who treated hyperglycemia- feedback • Order Sets- Delayed until mid-November • Office Visits/Physician Letter • Nursing Education- Late October

  18. Overall Mean Glucose

  19. Percent Patients Poorly Controlled

  20. Percent Patients at Goal

  21. Percent Patients with Hypoglycemia

  22. Percent Patients with Severe Hyperglycemia

  23. Percent Patients with 2 Blood Sugars >180

  24. Sliding Scale Alone

  25. Inappropriate Oral Diabetic Medication Use

  26. Outlook • Await implementation of interventions to monitor for true change in process • May need systematic real time reminders for order set usage and titration of insulin- nursing • Possible similar application to peri-operative arena and L&D if successful

  27. Thank You! Dr. Brent James Matt Frederiksen Cempaka Martial All ATP Staff Mary Griffin Alicia Fish Laurie Hansen Emory Johns Creek Glycemic Control Team

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