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 (healthit.gov)
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)
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FY23 Glycemic Management Improvement Tactics
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Focus Area
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Opportunities
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Q1 & Q2 Tactics for Improvement
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Status (Dec 2022)
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Reduce Preventable Glycemic Adverse Events (PAEs)
Events captured through coding and reviewed to determine if preventable
*Goal is Zero Preventable Harm
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Always prescribe and administer basal insulin to T1DM pts
Stop SGLT2i medication prior to surgery
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Education on Best Practices to Prevent DKA in the Hospital developed and disseminated
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14 events Jan - Dec 2020
39 events Jan - Dec 2021
30 of the 33 events reviewed Jan-Dec 2022 were preventable
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Hypoglycemia Reduction
Facility chart audits summarized to identify opportunities; provide feedback/education of involved staff
*Goal is Zero Preventable Harm
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Patients on SC insulin &
· Poor nutrition/no dextrose source
· On dialysis/change in renal function
· Basal dose too high
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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
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BSWH Critical Care Hypo - not meeting target
BSWH noncritical Care- not meeting target
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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
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Feedback from end users, Diabetes Council members, and Glycemic Control Order Set Workgroup used to identify opportunities
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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
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11 tickets in the queue
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