Hypoglycemia Management Using a Bundled Care Approach

A Quality Improvement Project

Abstract

Background: 

Hypoglycemia is a leading cause of preventable hospitalization, and can increase morbidity, mortality, and length of hospital stay. Up to 35% of diabetic patients experience severe hypoglycemia during hospitalization; this concerns veterans, as 25% have been diagnosed with diabetes.

Local Problem: 

A medical-surgical unit in a Veterans Affairs facility saw increased hypoglycemic episodes, with 26.8 episodes per 1000 patient days. Staff noted knowledge deficits with how to manage hypoglycemia episodes.

Methods: 

A pre-/post-implementation quality improvement project was conducted over 8 weeks.

Interventions: 

An implementation bundle was used to improve hypoglycemic episodes, including patient and staff education, coordination between meal delivery and insulin coverage, and developing a hypoglycemia protocol.

Results: 

Hypoglycemia rates significantly decreased to 10.27 per 1000 patient days (P = .001), and occasions where insulin was given with food increased significantly to 76.2% (P < .001).

Conclusions: 

A bundled approach was effective in decreasing hypoglycemia episodes and improved consistent management of hypoglycemia.