Improving Glycemic Management of the Inpatient Adult with Diabetes Mellitus through the Development of a Bedside Decision Support Tool for the Medical-Surgical Floor Nurse

Background: Uncontrolled blood sugar can lead to adverse events in the adult perioperative inpatient population. Hyperglycemia can lead to diabetic ketoacidosis (DKA), infection, delayed wound healing, increased hospital lengths of stay (LOS), and even mortality. Uncontrolled hypoglycemia can result in confusion, seizures, and even coma. Purpose: This single-PDSA-cycle quality improvement project aimed to prevent and/or minimize the duration of uncontrolled blood sugar in the peri-operative adult inpatient. The primary objective was to reduce the incidence of hyperglycemia defined as >180 mg/dL by at least 10% from baseline with a goal rate of less than 25%, while also reducing the incidence of hypoglycemia defined as < 70 mg/dL by at least 10% from baseline with a goal rate of less than 4.5%. The secondary aim of this project was to improve staff knowledge of glycemic protocols. Methodology: Interventions included education on potential negative patient outcomes due to uncontrolled blood sugars, training on existing hyperglycemia-related protocols and order sets, and the creation of a visual on-demand bedside decision support tool. Pre- and post-intervention surveys evaluated content learning. Pre- and post-implementation incidences of hyperglycemia and hypoglycemia measured project impact. Results: There was an 8.0% increase in nursing staff learning, an 8.0% reduction in the incidences of hyperglycemia, and a 34.1% increase in incidences of hypoglycemia after education and the implementation of a visual bedside decision support tool. Implications: Project interventions have been shown to improve the care provided to patients at risk for or with hyperglycemia while maintaining hypoglycemia goals. Recommendations for future studies include data collection on provider use of hyperglycemia-based order sets and the impact of uncontrolled hyperglycemia on metrics including post-admission DKA, infection, delayed wound healing, increased hospital LOS, and mortality.