Implementing and evaluating a multicomponent inpatient diabetes management program: putting research into practice

Abstract

Background: Strategies for successful implementation of hospitalwide glucose control efforts were addressed in a conceptual model for the development and implementation of an institutional inpatient glucose management program. CONCEPTUAL MODEL COMPONENTS: The Glucose Steering Committee incrementally developed and implemented hospitalwide glucose policies, coupled with targeted education and clinical decision support to facilitate policy acceptance and uptake by staffwhile incorporating process and outcome measures to objectively assess the effectiveness of quality improvement efforts. The model includes four components: (1) engaging staff and hospital executives in the importance of inpatient glycemic management, (2) educating staff involved in the care of patients with diabetes through structured knowledge dissemination, (3) executing evidence-based inpatient glucose management through development of policies and clinical decision aids, and (4) evaluating intervention effectiveness through assessing process measures, intermediary glucometric outcomes, and clinical and economic outcomes. An educational curriculum for nursing, provider, and pharmacist diabetes education programs and current glucometrics were also developed.

Outcomes: Overall the average patient-day-weighted mean blood glucose (PDWMBG) was below the currently recommended maximum of 180 mg/dL in patients with diabetes and hyperglycemia, with a significant decrease in PDWMBG of 7.8 mg/dL in patients with hyperglycemia. The program resulted in an 18.8% reduction in hypoglycemia event rates, which was sustained.

Conclusion: Inpatient glucose management remains an important area for patient safety, quality improvement, and clinical research, and the implementation model should guide other hospitals in their glucose management initiatives.

Figure 1

The model, which outlines and summarizes the core principles for establishment of a glucose management program, can be adapted locally to meet the needs and context of individual institutions. OAD, oral antidiabetic; A1C, glycosylated hemoglobin; DM, diabetes mellitus; IT, information technology; BG, blood glucose; LOS, length of stay; DKA, diabetic ketoacidosis.

Figure 2

Changes in the glucometric parameters were examined over the course of each discrete intervention time period (TP). JHH, Johns Hopkins Hospital.