Posters
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.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Arredondo, Hector; Pedraza Sanchez, Lina; Chang, Chelsea; Alshaikhli, Alfarooq; Fleires, Alcibiades; Bazan, D.; Gavilanes, Diana; Rajan, Don; Cabral, F.; Cantu, J.; Trejo, J.; Oliveira, K.; and Verduzco, R., "Improving inpatient hyperglycemia through an internal medicine resident and pharmacy audit and feedback quality improvement project" (2024). Research Symposium. 81.
https://scholarworks.utrgv.edu/somrs/2023/posters/81
Included in
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.