ACE/ADA Inpatient Diabetes and Glycemic Control Consensus Conference
Evolution of a Diabetes Inpatient Safety Committee

https://doi.org/10.4158/EP.12.S3.91Get rights and content

ABSTRACT

Objective

To develop a multidisciplinary team, the Diabetes Inpatient Safety Committee (DPSC), to effectively address the many barriers to achieving glycemic control in the inpatient setting.

Methods

The development, implementation, and successes of the DPSC are described.

Results

By focusing on prevention of severe hypoglycemia, the DPSC identified and addressed areas related to inpatient management that contributed to uncontrolled glucose levels. The introduction of a hypoglycemia treatment protocol was followed by the development of a standardized order set for use of sliding scale insulin, with the eventual introduction of an Insulin Order Set guiding the use of scheduled and correctional insulin. Protocols and guidelines addressing more specific areas of inpatient glycemic management (insulin pump therapy, perioperative management, diabetic ketoacidosis, intravenous insulin) also have been developed.

Conclusion

The successes of the DPSC to date have been directly related to strong institutional support, the dedication of a multidisciplinary team to address specific areas of glycemic management, the programmed introduction of order sets in conjunction with structured educational programs that accompany each protocol, and the use of quality improvement measures to evaluate the safety and efficacy of these protocols. Effective committees such as this will be instrumental in preventing errors and maximizing euglycemia. (Endocr Pract. 2006;12[Suppl 3]:91-99)

Section snippets

INTRODUCTION

The evidence in support of goal-directed management of hyperglycemia in patients hospitalized with known diabetes, previously unrecognized diabetes, and hospital-related hyperglycemia continues to grow 1, 2, 3, 4. Recently published guidelines recommend that glucose levels among hospital inpatients be maintained between 110 and 180 mg/dL, and even lower (80 to 110 mg/dL) for critically ill patients, as a way of reducing complications and hospital length of stay (1,5). Despite consensus among

FORMATION OF THE DIABETES PATIENT SAFETY COMMITTEE AT UPMC

UPMC Presbyterian, a 716-bed acute care adult medical/surgical referral hospital, is the flagship hospital of a network consisting of 19 hospitals and other care sites including doctors’ offices, outpatient specialty treatment and imaging centers, rehabilitation facilities, and nursing homes.

In July 2000, the hospital’s Medical Emergency Team (MET) identified several episodes of severe hypoglycemia among hospitalized patients, one of which was associated with poor outcome (17). The hospital

PEARLS FOR CREATING AND IMPLEMENTING HOSPITAL-WIDE PROTOCOLS

We have found that certain essential elements are required for successful protocol design and implementation. First, the support and backing of hospital administration is required. After our Hypoglycemia Protocol was implemented, the medical director of the hospital Patient Safety Committee helped disseminate the protocol and ensure its success by personally sending communication about it to all physicians at UPMC. He has subsequently supported our other protocols in a similar manner.

Second, it

CONCLUSION

Prior to establishment of the DPSC, the occurrence of hypoglycemia and hyperglycemia was not being reliably addressed despite the frequency with which it occurred. This fact was recognized following analysis of MET events, and spawned the formation of a committee initially focused on just one particular problem: the adverse consequences of hypoglycemia. From that narrow beginning, with the help of professionals from many fields, a comprehensive diabetes management program has evolved that is

ACKNOWLEDGMENT

This work was sponsored by funding from the United States Air Force, administered by the US Army Medical Research Acquisition Activity, Fort Detrick, Maryland, Award No. W81XWH-04-2-0030.

We thank Glory Koerbel for her very careful manuscript review, and Tracey Banks for her technical assistance in preparing the manuscript.

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    Presented at the American College of Endocrinology and American Diabetes Association Consensus Conference, Washington, DC, January 30-31, 2006.

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