Department of Medicine, Emory Johns Creek Hospital, Johns Creek, Georgia 30097, USA. hasan.shabbir@ emoryhealthcare.org
J Hosp Med. 2010 Jan;5(1):E15-20. doi: 10.1002/jhm.590.
Dysglycemia is prevalent in hospitalized patients and is associated with poor clinical outcomes. Educational interventions insufficiently improve best practices in managing dysglycemia.
To reduce dysglycemia by improving best practices for inpatient glycemic control.
Interrupted time series.
A community teaching hospital.
A total of 653 adult, noncritically ill, nonobstetric patients.
A real-time nursing intervention (RTNI). A charge nurse issued a verbal invitation to the physician to utilize the existing glycemic control order set for patients with dysglycemia.
(1) Lone correctional insulin (LCI) usage; (2) potentially inappropriate oral hypoglycemic medication (PIOHM) usage; (3) patient day-weighted mean glucose (PDWMG; ie, mean glucose for each hospital day, averaged across all hospital days); (4) the percent of patients with PDWMG >180 mg/dL; and (5) the prevalence of severe hypoglycemia.
The use of LCI regimens decreased from 48% to 30% (P < 0.01) during the RTNI period and the rate of potentially inappropriate oral hypoglycemic medications (PIOHMs) usage was reduced from 29% to 13% (P < 0.01). PDWMG decreased from 166 mg/dL to 156 mg/dL (P = 0.04). After removal of the RTNI, outcome measures were not significantly different from baseline, with the exception of PIOHM use, which remained lower at 19% in the postintervention group (P = 0.04).
An RTNI promoting a best-practice glycemic control order set was successful in modestly lowering mean glucose levels and substantially reducing the use of LCI and PIOHMs.
高血糖在住院患者中很常见，与不良临床结局相关。教育干预措施不足以改善高血糖管理的最佳实践。
通过改善住院患者血糖控制的最佳实践来降低高血糖。
间断时间序列。
一家社区教学医院。
共 653 名成年、非危重症、非产科患者。
实时护理干预（RTNI）。一名值班护士向医生发出口头邀请，要求其使用现有的高血糖控制医嘱集来治疗高血糖患者。
（1）单独校正胰岛素（LCI）的使用；（2）潜在不适当的口服降糖药（PIOHM）的使用；（3）患者日加权平均血糖（PDWMG；即，每个住院日的平均血糖，在所有住院日的平均值）；（4）PDWMG ＞ 180mg/dL 的患者比例；以及（5）严重低血糖的发生率。
在 RTNI 期间，LCI 方案的使用率从 48%降至 30%（P ＜0.01），潜在不适当的口服降糖药（PIOHM）的使用率从 29%降至 13%（P ＜0.01）。PDWMG 从 166mg/dL 降至 156mg/dL（P = 0.04）。在去除 RTNI 后，除 PIOHM 的使用仍处于较低水平（干预后组为 19%，P = 0.04）外，其他结果指标与基线相比没有显著差异。
推广最佳实践血糖控制医嘱集的 RTNI 成功地适度降低了平均血糖水平，并大大减少了 LCI 和 PIOHM 的使用。
