Factors Associated with Successful Implementation of an Inpatient Glycemic Management Program to Improve Glucose Control for Patients Needing Subcutaneous Insulin

Deployment and maturation of computerized medical records has improved insight into the unintended variability of glucose management in hyperglycemic inpatients. We used expert panels and extensive field testing to design a Glycemic Management Program to simultaneously reduce mean glucose levels and the frequency of hypoglycemic events. Factors observed as contributing to glucose control variation included over-use of sliding scale insulin; inconsistencies in timing, type and dose of insulin; and the alignment of blood glucose testing with meal tray delivery. We designed our Glycemic Management Program to address these factors with four distinct components: 1) Change management via targeted education; 2) Standardization of the ordering process for nutrition, blood glucose monitoring frequency, and a single subcutaneous insulin order set with decision support; 3) Standardization of workflow, including the timing and coordination of glucose testing and meal tray delivery; and 4) Patient specific, customized ongoing insulin dosing recommendations through FDA-approved decision support software. We implemented our Glycemic Management Program pilot in a 325 bed community hospital in the southeastern United States. Since its launch, 2277 patients have been managed on the program. By six months post-implementation, the rate of severe hypoglycemia (<54mg/dL) decreased 32.2% and basal-bolus insulin usage increased 135%. Average daily glucose values decreased without increasing the rate of hypoglycemia. Decreases were observed in overall length of stay (79%), complication rate (25.3%) and ICU length of stay (60%). A comprehensive program that incorporates decision support with attention to workflow, provider engagement, and education can result in improved glucose management in an inpatient setting. Feedback has led to programmatic changes to maximize positive outcomes and ensure sustainability. Disclosure R. Freeman: None. W.E. Gay: None. T.L. Garthwaite: Advisory Panel; Self; Ondine Biomedical. L. Hollis: None. J. McCannon (Bush): None. C. Spencer-Smith: None. E.E. Samuelson: None. P. Mehta: None.