A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results

Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are potentially life-threatening complications of diabetes. Many hospitals have developed protocols to guide the management of these conditions and align with best practices. One of the main complications encountered...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Katherine L. Modzelewski, Ariana Cannavo, Kathryn L. Fantasia, Sira Korpaisarn, Sara M. Alexanian
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Hyperglycemic crisis Diabetic ketoacidosis Insulin protocol Hypoglycemia Patient safety Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/6a9c1e7211f8494ca916c5bf26d0e2f6
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:6a9c1e7211f8494ca916c5bf26d0e2f6
record_format	dspace
spelling	oai:doaj.org-article:6a9c1e7211f8494ca916c5bf26d0e2f62021-11-06T04:29:10ZA quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results2214-623710.1016/j.jcte.2021.100269https://doaj.org/article/6a9c1e7211f8494ca916c5bf26d0e2f62021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2214623721000211https://doaj.org/toc/2214-6237Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are potentially life-threatening complications of diabetes. Many hospitals have developed protocols to guide the management of these conditions and align with best practices. One of the main complications encountered in the treatment of hyperglycemic crises is hypoglycemia. Methods: At our institution, we undertook a review of our insulin infusion titration protocol, rates of hypoglycemia, and time to clinical resolution for patients with hyperglycemic crises. A multidisciplinary team performed a literature review and analyzed baseline hospital data with the existing protocol. With the input of multiple stakeholders, several changes were made to the titration algorithm over multiple PDSA cycles to refine the protocol. Effectiveness and safety of the protocol, as well as fidelity with the protocol, were assessed after each PDSA cycle. Results: After the initial cycle, chart review showed a reduction in hypoglycemia rates of more than 50% in patients treated with the new protocol without any increase in time to resolution of DKA. A second version of the protocol was implemented to improve usability, and improvement in hypoglycemia was maintained. Conclusion: Despite the fact that the initial protocol had been developed based on best practice recommendations, rates of hypoglycemia were initially high. Critical assessment of pitfalls in management allowed changes to the protocol that significantly and sustainably reduced hypoglycemia.Katherine L. ModzelewskiAriana CannavoKathryn L. FantasiaSira KorpaisarnSara M. AlexanianElsevierarticleHyperglycemic crisisDiabetic ketoacidosisInsulin protocolHypoglycemiaPatient safetyDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENJournal of Clinical & Translational Endocrinology, Vol 26, Iss , Pp 100269- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hyperglycemic crisis Diabetic ketoacidosis Insulin protocol Hypoglycemia Patient safety Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	Hyperglycemic crisis Diabetic ketoacidosis Insulin protocol Hypoglycemia Patient safety Diseases of the endocrine glands. Clinical endocrinology RC648-665 Katherine L. Modzelewski Ariana Cannavo Kathryn L. Fantasia Sira Korpaisarn Sara M. Alexanian A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results
description	Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are potentially life-threatening complications of diabetes. Many hospitals have developed protocols to guide the management of these conditions and align with best practices. One of the main complications encountered in the treatment of hyperglycemic crises is hypoglycemia. Methods: At our institution, we undertook a review of our insulin infusion titration protocol, rates of hypoglycemia, and time to clinical resolution for patients with hyperglycemic crises. A multidisciplinary team performed a literature review and analyzed baseline hospital data with the existing protocol. With the input of multiple stakeholders, several changes were made to the titration algorithm over multiple PDSA cycles to refine the protocol. Effectiveness and safety of the protocol, as well as fidelity with the protocol, were assessed after each PDSA cycle. Results: After the initial cycle, chart review showed a reduction in hypoglycemia rates of more than 50% in patients treated with the new protocol without any increase in time to resolution of DKA. A second version of the protocol was implemented to improve usability, and improvement in hypoglycemia was maintained. Conclusion: Despite the fact that the initial protocol had been developed based on best practice recommendations, rates of hypoglycemia were initially high. Critical assessment of pitfalls in management allowed changes to the protocol that significantly and sustainably reduced hypoglycemia.
format	article
author	Katherine L. Modzelewski Ariana Cannavo Kathryn L. Fantasia Sira Korpaisarn Sara M. Alexanian
author_facet	Katherine L. Modzelewski Ariana Cannavo Kathryn L. Fantasia Sira Korpaisarn Sara M. Alexanian
author_sort	Katherine L. Modzelewski
title	A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results
title_short	A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results
title_full	A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results
title_fullStr	A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results
title_full_unstemmed	A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results
title_sort	quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: insights and results
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/6a9c1e7211f8494ca916c5bf26d0e2f6
work_keys_str_mv	AT katherinelmodzelewski aqualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT arianacannavo aqualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT kathrynlfantasia aqualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT sirakorpaisarn aqualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT saramalexanian aqualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT katherinelmodzelewski qualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT arianacannavo qualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT kathrynlfantasia qualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT sirakorpaisarn qualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults AT saramalexanian qualityimprovementinitiativetosuccessfullyreducethefrequencyofhypoglycemiaduringtreatmentofhyperglycemiccrisesatanacademicsafetynethospitalinsightsandresults
_version_	1718443921096310784

A quality improvement initiative to successfully reduce the frequency of hypoglycemia during treatment of hyperglycemic crises at an academic safety-net hospital: Insights and results

Ejemplares similares