28-4E42 Use of the improvement model to reduce hyperglycemia in adult patients hospitalized

• Published in: BMJ open quality Vol. 13; no. Suppl 3; p. A13
• Main Authors: Berlanda, Gabriela, Souza, Luiza Daniel de, Lima, Juliana da Silva, Tortato, Caroline, Pasin, Simone Silveira, Rotta, Eloni Terezinha, Hemesath, Melissa Prade, Parulla, Cibele Duarte, Hammes, Thais Ortiz, da Rosa Indriunas Perdomini, Fernanda, Schnorr, Claudia Carolina, Nascimento Da Silva Cebulski, Jenifer, Kaspary, Eunice Maria, Freitas, Carlos Eduardo de, Santos, Helena Barreto dos, Leitão, Cristiane Bauermann, D Agord Schaan, Beatriz
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 15.08.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Antidiabetics; Glucose; Hospitalization; Hyperglycemia; Hypoglycemia; Insulin; Patients
• ISSN: 2399-6641
• DOI: 10.1136/bmjoq-2024-QSH.27

IntroductionHospital hyperglycemia is a frequent complication in hospitalized patients, reaching a prevalence of 38%. It is usually associated with an increased risk of adverse events (infections, hypoglycemia, mortality) and greater use of resources, length of stay and costs.ObjectiveTo reduce by 50% the average daily blood glucose (ADBG) rate > 180mg/ dL of non-critically ill patients admitted to a surgical ward at a public tertiary care hospital until June 2023.MethodsThis project was developed between April 2022 and June 2023 using the Improvement Model (IM) method. The driver diagram (DD) was used to prioritize actions and to structure changes to be made, and the Healthcare Failure Modes and Effects Analysis (HFMEA) was used to identify and analyse failure modes related to the hyperglycemia management process. The PDSA tool (Plan, Do, Study, Act) was used to develop the change process. Data were collected using standardized forms and accompanied by trend graphs for the best understanding of the variations, considering as outcomes the indicators of process, results and balance. The process indicators used were related to nonconformities in medical prescriptions and insulin administration. The result indicators were the rate of ADBG>180mg/dL and the rate of ADBG>300mg/dL; the balance indicator was the rate of hypoglycemia (<70 mg/dL) for every 100 patient-days using oral antidiabetic medication or insulin.ResultsThe DD was structured with 12 changes that focused on the implementation of the protocol, adequate medical prescription and correct administration of insulin, adequate monitoring of blood glucose, appropriate diet prescription, measurement and dissemination of indicators, leadership engagement, educational actions and definition of roles and responsibilities. There was a reduction of 69% in the rate of ADBG>180 mg/dL and 100% for ADBG>300mg/dL, which was associated with an increase from 8 to 11 hypoglycemic events for every 100 patient-days using oral antidiabetic medication or insulin. There was also a reduction in the rates of nonconformities in medical prescription and insulin administration, with a reduction of 50% and 71%, respectively.ConclusionThe use of the IM emphasizing different approaches in this project led to improved prescription practices, insulin administration and blood glucose control, reducing the rate of hyperglycemia in hospitalized patients and showing satisfactory results in a pilot project. However, higher rates of hypoglycemia are a matter of concern.