Background: Dysglycemia is prevalent in hospitalized patients and is associated with poor clinical outcomes. Educational interventions insufficiently improve best practices in managing dysglycemia.
Objective: To reduce dysglycemia by improving best practices for inpatient glycemic control.
Design: Interrupted time series.
Setting: A community teaching hospital.
Patients: A total of 653 adult, noncritically ill, nonobstetric patients.
Intervention: A real-time nursing intervention (RTNI). A charge nurse issued a verbal invitation to the physician to utilize the existing glycemic control order set for patients with dysglycemia.
Measurements: (1) Lone correctional insulin (LCI) usage; (2) potentially inappropriate oral hypoglycemic medication (PIOHM) usage; (3) patient day-weighted mean glucose (PDWMG; ie, mean glucose for each hospital day, averaged across all hospital days); (4) the percent of patients with PDWMG >180 mg/dL; and (5) the prevalence of severe hypoglycemia.
Results: The use of LCI regimens decreased from 48% to 30% (P < 0.01) during the RTNI period and the rate of potentially inappropriate oral hypoglycemic medications (PIOHMs) usage was reduced from 29% to 13% (P < 0.01). PDWMG decreased from 166 mg/dL to 156 mg/dL (P = 0.04). After removal of the RTNI, outcome measures were not significantly different from baseline, with the exception of PIOHM use, which remained lower at 19% in the postintervention group (P = 0.04).
Conclusions: An RTNI promoting a best-practice glycemic control order set was successful in modestly lowering mean glucose levels and substantially reducing the use of LCI and PIOHMs.
(c) 2010 Society of Hospital Medicine.