ACE/ADA Inpatient Diabetes and Glycemic Control Consensus ConferenceEvolution of a Diabetes Inpatient Safety Committee
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.