Stoner Michael J, Burkey Kelli S, Cohen Daniel M
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Pediatric Emergency Department, Nationwide Children's Hospital, Columbus, Ohio.
Pediatr Qual Saf. 2019 Jul 22;4(4):e194. doi: 10.1097/pq9.0000000000000194. eCollection 2019 Jul-Aug.
Treatment of diabetic ketoacidosis (DKA) requires close and timely monitoring to prevent serious adverse events. This quality improvement project details how our institution improved blood glucose monitoring around hospital admission. The project aimed to increase the blood glucose assessments for children with DKA receiving insulin in the emergency department (ED) within 30 minutes before transitioning to an inpatient unit.
We implemented a series of Plan-Do-Survey-Act (PDSA) cycles established by a multidisciplinary team for this project, with the primary outcome of obtaining the blood glucose level within 30 minutes before leaving the ED and secondarily preventing episodes of hypoglycemia. These PDSAs harnessed the electronic health record, to prompt and direct the medical staff, to improve blood glucose monitoring.
From March 2015 to November 2017, we saw 640 patients in our ED for DKA. Of these, we admitted 629 to the inpatient unit with treatment that included continuous infusion of insulin. Over this period, we increased blood glucose monitoring for these patients within 30 minutes before the transition from 56% to >90%. Following the final PDSA cycle, we observed no reported episodes of hypoglycemia.
Using the functionality of the electronic health record, we showed significant, rapid, and sustained increases in compliance with the International Society for Pediatric and Adolescent Diabetes guideline by alerting ED staff caring for patients receiving continuous insulin around the time of care-team transitions. We believe that this program is easily replicable, cost-effective, and safety enhancing.
糖尿病酮症酸中毒（DKA）的治疗需要密切且及时的监测，以预防严重不良事件。本质量改进项目详细介绍了我们机构如何在入院前后改进血糖监测。该项目旨在增加在急诊科（ED）接受胰岛素治疗的DKA患儿在转至住院病房前30分钟内的血糖评估。
我们实施了一系列由多学科团队为此项目制定的计划-执行-调研-行动（PDSA）循环，主要成果是在离开急诊科前30分钟内获取血糖水平，其次是预防低血糖发作。这些PDSA循环利用电子健康记录来提示和指导医务人员，以改善血糖监测。
从2015年3月至2017年11月，我们急诊科共收治了640例DKA患者。其中，629例被收入住院病房，接受包括持续输注胰岛素在内的治疗。在此期间，我们将这些患者在转科前30分钟内的血糖监测率从56%提高到了90%以上。在最后一个PDSA循环之后，我们未观察到有低血糖发作的报告。
通过利用电子健康记录的功能，我们显著、迅速且持续地提高了对国际儿童和青少年糖尿病学会指南的依从性，方法是在护理团队交接时提醒急诊科护理接受持续胰岛素治疗患者的工作人员。我们认为该项目易于复制、具有成本效益且能提高安全性。
