A Blood Glucose Monitoring Pilot Project for Patients with Hyperglycemia on Admission to the Hospital
Abstract Number: 0429-P
Authors: JOYCE D. HALL, KERRY MRSNY, MICHAEL ROMANO, JEANIFFR SNIDE, ADRIENNE SOILEAU, SONDRA GROTZ, WHITNEY GOLDNER, Omaha, NE
Results: The scientific and clinical evidence regarding hyperglycemia risks to hospitalized patients is well documented. Risks include increased mortality and morbidity, higher rates of infection, longer lengths of stay, increased ICU stays, and more nursing home care.
Hyperglycemia is not limited to persons with diabetes. Multiple factors cause hyperglycemia in hospitalized patients including the stress of illness, trauma or surgery with increased insulin resistance and drug-induced hyperglycemia from steroids, immune suppressant drugs, antivirals and atypical antipsychotics. In addition, some patients have diabetes but are undiagnosed until hospitalization.
The Six Sigma Blood Glucose Management Team at The Nebraska Medical Center developed a pilot project to identify patients with hyperglycemia on admission. A prior project identified a lack of orders for blood glucose monitoring in patients with previously diagnosed diabetes. The pilot project included a process for initiating blood glucose monitoring.
The project goals were to identify all adult non-ICU inpatients with or without diabetes who had blood glucose values on admission greater than 180 mg/dL and initiate blood glucose monitoring on all adult non-ICU inpatients with diabetes with no orders for monitoring. The pilot was conducted from July 17 to September 18, 2006.
Out of 1001 patients admitted over two months, 127/1001 (13%) were identified as having hyperglycemia in the first 24 hours of admission. Of those 1001 patients, 23/1001 (18%) didn't have diabetes by history. Of the patients admitted, 299/1001 (30%) had a diagnosis of diabetes. Nurses initiated scheduled blood glucose monitoring on 36/299 (12%) patients with diabetes admitted without orders for monitoring.
These data suggest that hospitals should have a mechanism in place for identifying all patients with hyperglycemia on admission to alert physicians so that interventions can be timely. Additionally, nurse-initiated blood glucose monitoring should be a standard for all patients with diabetes who have no orders for scheduled monitoring.