Posters

Presenting Author

Hector Arredondo

Presentation Type

Poster

Discipline Track

Clinical Science

Abstract Type

Research/Clinical

Abstract

Background: Although the advantages of proper glycemic control in hospitalized patients with diabetes are well-established, a variety of barriers limit accomplishment of blood glucose targets. Inpatient hyperglycemia is associated with an increase in morbidity and mortality, number of re-hospitalizations, and length of hospitalization. Our aim was to decrease the number of glucose values above 180mg/dl in non-critical care hospitalized patients using an audit and feedback intervention with pharmacy and internal medicine residents.

Methods: A resident-led multidisciplinary team implemented the quality improvement (QI) project including conception, literature review, educating residents, iterative development of audit and feedback tools, and data analysis. The multi-disciplinary team met every 5 weeks and undertook three “plan-do-study-act” cycles over an 8-month period (August 2022 to March 2023) to educate residents on inpatient hyperglycemia management, develop and implement an audit and feedback process, and assess areas for improvement.

Results: We performed 1045 audits analyzing 16,095 accu-checks on 395 non-duplicated patients. The majority of audits showed compliance with guidelines. We have a monthly run-on chart showing percent of glucose values above 180mg/dl in our non-ICU hospitalized patients as well as an overall pre to post comparison of 25.1% to 23.0% (p-value <0.05). The feedback was well-accepted by residents evidenced by survey results.

Conclusion: We did not meet our primary aim to reduce hyperglycemia by 30% and this combined with the audits showing mostly compliance with guidelines suggests that prescribing behavior was not a key driver of inpatient hyperglycemia in our population. This internal medicine resident and pharmacy interprofessional collaboration with audit and feedback for inpatient hyperglycemia was feasible, well-accepted and had a statistically significant yet small improvement in inpatient hyperglycemia. The project may be helpful to others wishing to explore inpatient hyperglycemia, interprofessional QI with pharmacists, resident-led QI and audit and feedback.

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Improving inpatient hyperglycemia through an internal medicine resident and pharmacy audit and feedback quality improvement project

Background: Although the advantages of proper glycemic control in hospitalized patients with diabetes are well-established, a variety of barriers limit accomplishment of blood glucose targets. Inpatient hyperglycemia is associated with an increase in morbidity and mortality, number of re-hospitalizations, and length of hospitalization. Our aim was to decrease the number of glucose values above 180mg/dl in non-critical care hospitalized patients using an audit and feedback intervention with pharmacy and internal medicine residents.

Methods: A resident-led multidisciplinary team implemented the quality improvement (QI) project including conception, literature review, educating residents, iterative development of audit and feedback tools, and data analysis. The multi-disciplinary team met every 5 weeks and undertook three “plan-do-study-act” cycles over an 8-month period (August 2022 to March 2023) to educate residents on inpatient hyperglycemia management, develop and implement an audit and feedback process, and assess areas for improvement.

Results: We performed 1045 audits analyzing 16,095 accu-checks on 395 non-duplicated patients. The majority of audits showed compliance with guidelines. We have a monthly run-on chart showing percent of glucose values above 180mg/dl in our non-ICU hospitalized patients as well as an overall pre to post comparison of 25.1% to 23.0% (p-value <0.05). The feedback was well-accepted by residents evidenced by survey results.

Conclusion: We did not meet our primary aim to reduce hyperglycemia by 30% and this combined with the audits showing mostly compliance with guidelines suggests that prescribing behavior was not a key driver of inpatient hyperglycemia in our population. This internal medicine resident and pharmacy interprofessional collaboration with audit and feedback for inpatient hyperglycemia was feasible, well-accepted and had a statistically significant yet small improvement in inpatient hyperglycemia. The project may be helpful to others wishing to explore inpatient hyperglycemia, interprofessional QI with pharmacists, resident-led QI and audit and feedback.

 

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