Assessing Improvements to Reduce Insulin-Related Hypoglycemic Events | ASHP Midyear
Medication alerts, nurse education, and pharmacist interventions led to lower hypoglycemic events every year after they were implemented.
Strategic systematic and operational improvements implemented and driven by pharmacy leaders could help reduce the total number of insulin-related hypoglycemic events within a hospital, according to new research presented at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana.1
Assessing Improvements to Reduce Insulin-Related Hypoglycemic Events | ASHP Midyear / Sherry Young - stock.adobe.com
Insulin is key to glycemic control in patients with diabetes and is the recommended therapy to treat hyperglycemia during hospitalization. However, insulin therapy has associated risks and can result in insulin-related hypoglycemic events. Research has shown insulin may be implicated in 33% of medication error–related deaths, can lead to increased lengths of stay and reduced insurance reimbursements for conditions acquired in the hospital.2
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A team of investigators from Methodist Hospital of Southern California and Cardinal Health conducted a study to assess if systematic and operational improvements decreased the incidence of insulin-related hypoglycemia events. The retrospective review compared hypoglycemic events from 2017 before improvements were implemented to 2018 through 2023 after improvements were implemented. Data was gathered from Arcadia Hospital’s Electronic Health Record reporting tool.
The systematic and operational improvements that were implemented during the study included medication alerts, nurse education, and pharmacist interventions like frequent glucose checks during rounds for patients receiving insulin. The primary endpoint was the decrease in number of insulin-related hypoglycemic events after the implementation of systematic improvements. Secondary endpoints included decreased usage of Dextrose 50% and Glucagon, and decreased overall hospital cost.
The study found that there were 74 hypoglycemic events 1 year after adding safety alerts at order entry and drug removal from automated dispensing devices, compared to 111 the year before such measures were implemented. After implementing nursing education and pharmacist monitoring at order entry and during patient rounds, hypoglycemic events decreased every year. In 2018, there were 74 events, followed by 27 in 2019, 50 in 2020, 42 in 2021, and 38 in 2022.
Additionally, with an average marginal cost of $4312 for 1 hypoglycemic event, researchers estimated that the cost of healthcare expenses for 111 events in 2017 was $478630. After implementing the improvements, the total cost was estimated to be $319088 for 74 events in 2018. Over the entire 5 year study period, there was a total reduction in average cost of 58%, with average costs totaling $279417.
“Implementing systematic improvements such as safety alerts for prescribers and nurses, the implementation of nursing, pharmacy, and medical staff education, and having pharmacy interventions with recommendations to stop long-acting insulin, holding insulin doses for specific patient, based on meal consumption, and frequent glucose checks during rounds for patients receiving insulin, reduced the overall number of insulin-related hypoglycemic events,” the authors concluded.
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