Benbrahim Meissane, Cashman Lauri, Baker William E, Gendron Bryan J, Lookabill Sara, Farrell Natalija
Department of Pharmacy, Boston Medical Center, Boston, Massachusetts (Drs Benbrahim, Gendron, Lookabill, and Farrell); and Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts (Drs Cashman, Baker, Gendron, Lookabill, and Farrell).
Qual Manag Health Care. 2022;31(4):244-250. doi: 10.1097/QMH.0000000000000340. Epub 2022 Feb 7.
The aim of this quality improvement project was to decrease the percentage of emergency department (ED) patients admitted with blood glucose (BG) level above 250 mg/dL to less than 20%.
A work group comprised physicians, pharmacists, and endocrinologists collaborated to standardize management of ED hyperglycemia. Plan-Do-Study-Act cycles included education, monitoring of patients with BG level above 200 mg/dL, and development of an ED-specific insulin protocol.
Following the initiative, 24.8% fewer patients were admitted with BG level above 250 mg/dL. The average admission BG level was reduced by 65.8 mg/dL, creating a significant shift toward improved average BG level. No difference was seen in hospital mortality, hospital length of stay, ED length of stay, hypoglycemia, or inhospital diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome.
Implementation of a standardized hyperglycemia treatment protocol along with pharmacist interventions reduced average admission BG and the percentage of patients with BG level above 250 mg/dL on admission.
本质量改进项目的目的是将急诊科（ED）血糖（BG）水平高于250mg/dL的入院患者比例降至20%以下。
一个由医生、药剂师和内分泌学家组成的工作小组合作，规范急诊科高血糖的管理。计划-实施-研究-改进循环包括教育、对BG水平高于200mg/dL的患者进行监测，以及制定针对急诊科的胰岛素治疗方案。
该项目实施后，BG水平高于250mg/dL的入院患者减少了24.8%。平均入院BG水平降低了65.8mg/dL，使平均BG水平显著改善。在医院死亡率、住院时间、急诊科停留时间、低血糖或住院期间糖尿病酮症酸中毒或高渗高血糖综合征方面未发现差异。
实施标准化的高血糖治疗方案并结合药剂师干预，降低了平均入院BG水平以及入院时BG水平高于250mg/dL的患者比例。
