Advisor
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Abstract
Problem: Inpatient hypoglycemia raises mortality by up to 7% and is associated with increased costs and length of stay. The average monthly adherence to glycemic management guidelines in the latter half of 2023 at the project site was 54.3% hospital-wide and 65% on the project unit. Purpose: The purpose of this quality improvement project was to increase weekly hypoglycemia protocol adherence to 100% among nursing staff caring for patients on the proposed unit. Process goals included increasing adherence rates of hypoglycemia documentation, timely blood glucose rechecks, and appropriate treatment per protocol or provider orders. Methods: The project population was nursing staff caring for adult inpatients at risk for hypoglycemia. The setting was an intermediate care unit at a community hospital in the fall of 2024. The intervention centered around a clinical decision support tool accessible via a quick response code affixed to glucometers as part of a hypoglycemia protocol adherence bundle, which included daily huddle reminders and individualized feedback provided to nursing staff. Data collection was conducted through weekly chart audits and charge nurse surveys. Results: 63 hypoglycemia events occurred across 45 patients; median adherence rates were 83.3% for both documentation and timely glucose rechecks, 100% for appropriate treatment, and 66.7% for overall hypoglycemia protocol adherence. Staffing shortages and newly hired staff likely explain decreases in adherence. Discussion: 100% adherence was achieved on weeks 7, 11, 12, & 13. The bundle increased the unit’s median adherence to hypoglycemia protocols, improving consistency in documenting, reassessing, and treating hypoglycemia. Limitations included staff turnover, limited staff collaboration/charge nurse engagement, and practice drift. Conclusions: The adherence bundle is useful, safe, and cost-effective. It can be implemented and modified to best meet the needs of each unit’s population. To sustain change, project leadership was transferred to the diabetes champion with continued support from unit leadership to improve the culture of safety around glycemic management. This project warranted no additional costs to the organization and prevented costs associated with severe hypoglycemia. Future electronic health record updates could allow diabetes champions and charge nurses to monitor entire units for hypoglycemia events throughout their shifts.
