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Tips for Championing Glycemic Metrics

By Jennifer Clements posted 27 days ago


Tips for Championing Glycemic Metrics

Written by Barbara Kocurek


Most of us are aware of the detrimental effects of high and low blood glucose on patients, however many on our health care team are not, especially in the hospital setting. We also know that the use of data, e.g., glycemic metrics, can help identify opportunities to improve care and reduce hospital harm events. Below are some tips to gain support to establish and sustain the use of glycemic metrics in your hospital.

Identify Your Goals
What do you want to accomplish, either immediately or long term? Having clear goals helps shape your communication and be more effective.

TIP:  Our health care system uses the SBAR tool as a standard communication framework to define issues and recommendations. Here is an example of an SBAR used to gain approval for building our glycemic metric reports.

Situation:  Hyperglycemia (blood glucose greater than 180 mg/dL) and hypoglycemia (blood glucose less than 70 mg/dL) in hospitalized patients can contribute to increased morbidity, mortality, length of stay.

Background: No standardized reports available to quantify hyperglycemia or hypoglycemia.

Assessment: The lack of standardized glycemic metric data makes it difficult to identify improvement opportunities and is a barrier to improving patient care and safety.

Recommendation: Develop glycemic metric reports to determine rates of hyperglycemia and hypoglycemia and identify areas of opportunity.

Determining what glycemic metrics will be measured has been a challenge since there have not been national benchmarks. However, that will soon change as this year CMS has added eCQM (electronic clinical quality measures) for severe hyperglycemia and hypoglycemia. At this time the reporting of these measures is voluntary, however will most likely be mandatory at some point in the future. To learn more about these measures: Eligible Hospital / Critical Access Hospital eCQMs | eCQI Resource Center (

Listen Actively
Communication isn’t just about what you say or write. If you want people to listen to you, you need to listen to them. Don’t get so focused on your message that you miss their comments and reactions. When everyone is actively involved, communication is more effective, and you can often find your senior leadership champions this way.

TIP: When possible, align your work with hospital or healthcare system strategies. At the end of the blog is an example of our Diabetes Council FY23 initiatives which is shared quarterly with senior leadership.

TIP:  Pace yourself – it is often a marathon and not a sprint. Making changes can be challenging, especially in a busy healthcare system where there are competing priorities.

Use the data to identify opportunities for improvement. We summarize our data quarterly and annual and use that data to make changes to our Epic insulin order sets, glycemic management workflows, and update our education offerings.

As diabetes care and education specialists we have the expertise to improve the care of patients in the hospital.  I have shared a handful of things that I do to accomplish this and would love to hear what others have done!

FY23 Focus Areas (example)

FY23 Glycemic Management Improvement Tactics

Focus Area


Q1 & Q2 Tactics for Improvement

Status (Dec 2022)

Reduce Preventable Glycemic Adverse Events (PAEs)

Events captured through coding and reviewed to determine if preventable

*Goal is Zero Preventable Harm

Always prescribe and administer basal insulin to T1DM pts


Stop SGLT2i medication prior to surgery

 Education on Best Practices to Prevent DKA in the Hospital developed and disseminated


14 events Jan - Dec 2020

39 events Jan - Dec 2021

30 of the 33 events reviewed Jan-Dec 2022 were preventable

Hypoglycemia Reduction

Facility chart audits summarized  to identify opportunities; provide feedback/education of involved staff

*Goal is Zero Preventable Harm

Patients on SC insulin &

·        Poor nutrition/no dextrose source

·        On dialysis/change in renal function

·        Basal dose too high

NPO guidelines to add to Glycemic Management Guidelines


Learn Lessons on CGM and Insulin Pump use in the hospital created


Reviewed and updated Hypo SDO

BSWH Critical Care Hypo - not meeting target

BSWH noncritical Care- not meeting target

Evidence-based Glycemic Control Order Sets

Every SNOW ticket is evaluated to determine if patient safety issue that needs to be addressed immediately
*Goal is reduced variation through standardized formatting and clear presentation of orders

Feedback from end users, Diabetes Council members, and Glycemic Control Order Set Workgroup used to identify opportunities

Held Glycemic Order Set Review with provider focus group and nursing focused group


Insulin Pump Policy reviewed and updated


Updates to Epic Hyperkalemia Trt OS went live


Updates to IV Insulin 140-180 OrderSet went live

11 tickets in the queue




20 days ago

Great advice, @Barbara Kocurek! I also appreciate the simplicity of your focus areas grid. Thanks for sharing. 

27 days ago

@Lisa Laird we are a 25 plus hospital system, with two teaching hospitals.  The Glycemic Management Guidelines are available via a link in Epic.  I hope that is helpful information.  You may have asked another question but when I hit Add a comment, it covers up your post.

27 days ago

This is great information. Thank you for being candid. Please share more about hospital glycemic guidelines? How did you go about implementing those? and are you a teaching hospital with various services contributing to patient care?

I look forward to learning more. Thanks again.