Improving Glycemic Control in an Inpatient Setting Through Implementation of a Glycemic Control Team
Lonnye Finneman, Pharm.D., Sarah Sherington, Pharm.D., Chris Hogness, M.D., M.P.H, Kristen Wilson, Pharm.D., BCPS, Erin Thorsgard, Pharm.D., Ryan Parker, Pharm.D., Kathryn Gaudette, Pharm.D.
Southwest Washington Medical Center, Vancouver, Washington
Recent evidence has demonstrated that aggressive glucose control in the inpatient setting improves clinical outcomes. The benefits of improved glucose control include reduced mortality, reduced morbidity, and reduced costs of care. The purpose and goal of the Glycemic Control Team are to improve the glucose management of inpatients.
The Glycemic Control Team was implemented in October 2006. The Team consists of a full-time equivalent pharmacist, a full-time certified diabetic educator (CDE), and a physician who is available for oversight seven days a week. Additional pharmacists have been trained to answer questions during times when the Team is not available. The initial focus of the Glycemic Control Team was the management of surgical patients. Referrals from other providers with patients whose glucose control has been difficult to manage were a secondary focus. The pharmacist is responsible for identifying surgical patients with diabetes or hyperglycemia and then managing the medication therapy and monitoring of glucose levels. The CDE provides education to the patients on dietary management and insulin use and monitoring, and assists with coordinating diabetes management upon discharge.
The Team is managing an average of 14 patients per day. The average glucose level has decreased from 165.4 mg/dL in January 2006 to 148.5 mg/dL in August 2007. When specifically evaluating the results on the post-surgical units, the average glucose value decreased from 162.2 mg/dL to 143.9 mg/dL on the general surgery unit and from 182.7 mg/dL to 150.7 mg/dL on the orthopedic/neurologic surgery unit from January 2006 to July 2007. Likewise, the percent of glucose readings in the goal range of 70–180 mg/dl for all non-critical care nursing units increased from 62.4% in January 2006 to 72.5% in August of 2007. In the Intensive Care Unit (ICU), the percent of readings in the range of 70–150 mg/dl increased from 66% to 74.4%. In addition, the percent of patients on insulin therapy who received basal insulin increased from an average of 42.4% to 52.6% since implementation of the Glycemic Control Team. The average length of stay for surgical patients receiving insulin therapy decreased from 9.8 days in June 2006 to 7.8 days in August 2007.
Improvements in glycemic control can be accomplished through implementation of a multidisciplinary team that is responsible for the daily management and coordination of care for patients with diabetes or hyperglycemia. Because of their knowledge and skills, pharmacists are critical to the success of an aggressive glycemic control management program.
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