Inpatient Hyperglycemia Management by Pharmacy; Hyperglycemia

Hyperglycemia in hospitalized patients with or without a prior diagnosis of diabetes can lead to adverse events, re-hospitalizations, and increased morbidity and mortality. The purpose of this study was to determine if implementing a pharmacist-driven protocol could improve the management of hyperglycemia and the utilization of basal-bolus insulin. The project occurred in 5 phases. In phase 1, an extensive review of literature was performed to develop a protocol. In phase 2, the protocol was reviewed with the internal medicine team with pre and post surveys of current practices and utilization. Phase 3 was development of a protocol referencing the gathered information. In phase 4, the protocol was implemented. Finally, in phase 5, data was gathered and evaluated using reports generated by the electronic medical records system. Over a selected 1-month period, 1,091 patients were admitted into the hospital, and of those patients, 255 were diabetic patients. Pharmacists were consulted on 150 out of the 255 diabetic patients. During the month of intervention, there were 180 (2.90%) blood glucose draws that were less than 70mg/dL. Basal-bolus insulin was utilized on 156 patients (61.17%). This intervention resulted in an 8.96% increase in basal-bolus utilization compared to the previous month when patients were followed by providers only. This study showed insulin therapy can be safely and effectively initiated and managed by pharmacists using a standardized approach. Implementation of the protocol was effective in improving the usage of basal-bolus insulin in this setting/project. Further evaluation is needed to determine the effectiveness in other settings.