ASHP Best Practices Award Mortar and Pestle
Award Information

Implementation of a Pharmacist-Led, Interprofessional Diabetes Management Team in an Inpatient Setting

Anna M. Baldwin, Pharm.D., BCPS, Phil Ayers, Pharm.D., BCNSP, FASHP, Virginia Wallace, Pharm.D., BCPS, Carman R. Dixon III, Pharm.D., Laurie Warrington, Pharm.D., BC-ADM, BCACP, Krista D. Riche, Pharm.D., BCPS, Natalie Mosley, Pharm.D.

 

Mississippi Baptist Health Systems, Jackson, Mississippi

Management of hospitalized diabetic patients is a universal concern. Blood glucose control in this setting has shown to decrease infection rates, improve morbidity and mortality, reduce length of stay, and decrease healthcare costs.1,2 In 2006, the American College of Endocrinology and the American Diabetes Association issued a “Call to Action” to encourage an interprofessional team approach to optimize diabetes care.3 In response, our institution developed a Diabetes Management Team (DMT). The primary goal of the DMT is to provide optimal glucose control for hospitalized patients by utilizing a clinical pharmacist-led, interprofessional team.

The DMT was implemented in November 2008, initially focusing on patients undergoing cardiovascular (CV) surgery. The DMT now accepts consults for any patient with hyperglycemia or hypoglycemia and is available 24 hours a day. The DMT consists of five pharmacists, ten physicians, two certified diabetic educator (CDE) nurses, and a registered dietician. A full-time equivalent clinical pharmacist is responsible for managing hyperglycemic medication therapy for consulted patients. Additional pharmacists assist after hours and on weekends. The physicians evaluate patients on initial consultation and provide oversight. The CDE nurses provide education on insulin administration, glucose monitoring, and diabetic principles. The dietitian provides diabetic meal instruction. Discharge management is coordinated by the DMT.

The DMT manages an average of 15-20 patients daily and consults have increased from an average of forty per month in 2009 to over ninety per month currently. A case study was recently published in the American Journal of Health-System Pharmacy highlighting the success of the DMT in controlling postoperative day one (POD1) and postoperative day two (POD2) blood glucoses to less than 200mg/dL in CV surgery patients. The percentage of controlled patients increased from 60.4% annually in 2008 to 96.2% currently. Advanced Certification in Inpatient Diabetes was awarded to the DMT by the Joint Commission in 2012.  Critical elements for this certification included: improvement in the percentage of patients with a glycosolated hemoglobin drawn on admission or within three months from 42.8% to 77.3% monthly; identification of causes and a decrease in frequency of hypoglycemic events; the percent of POD1 and POD2 blood glucoses less than 200mg/dL in CV surgical patients remains greater than 95% annually; overall patient satisfaction following diabetic education remains greater than 98.7% annually. Additionally, an outpatient diabetes clinic was developed to improve diabetic control, reduce readmissions, and allow for continuity of care.

Improvements in glycemic control for hospitalized patients can be accomplished by implementing a pharmacist-led, interprofessional team. The success and sustainability of the DMT demonstrates that pharmacists are an integral component in achieving glycemic control, leading to improvements in patient outcomes.  Inpatient glycemic control provides an ideal opportunity for collaboration between pharmacists and other healthcare providers.

References:

  1. Umpierrez GE, Isaacs SD, Bazargan N et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clini Endocrinol Metab. 2002; 87:978-82.
  2. Van den Berghe G, Wouters P, Weekers F et al. Intensive insulin therapy in critically ill patients.  N Engl J Med. 2001; 345:1359-67.
  3. ACE/ADA Task Force on Inpatient Diabetes. American College of Endocrinology and American Diabetes Association consensus statement on inpatient diabetes and glycemic control. Diabetes Care. 2006; 29:1955-62.

View a pdf of the poster from the Midyear Meeting (259 KB)