COVID-19, Medication Safety

Collaborate to Innovate: Leveraging Clinical Leadership to Reimagine Glycemic Management

Glycemic management can be difficult and costly for many hospitals across the country. Teams tasked with managing patients’ glycemic health are typically siloed and unable to collaborate effectively. Additionally, relevant patient data is rarely aggregated, accessible or actionable, and nearly 90% of American hospitals continue to treat glycemic issues with confusing, ineffective, one-size-fits-all protocols.

Poor glycemic management can lead to dire consequences for patients and hospitals, and the COVID-19 pandemic has exacerbated existing challenges. Not only are hospitals and their staff stretched thin as a result of the pandemic, but patients living with diabetes and COVID-19 tend to have prolonged hospital stays, additional complications and increased risk for worse outcomes. Furthermore, about 80% of COVID-19 patients receive steroids as part of their treatment, which can complicate glycemic control for all patients (even those without diabetes).

During a recent Becker’s Clinical Leadership and Pharmacy Virtual Forum, Cathy Rolih, MD, clinical physician executive of the Diabetes Center of Excellence at Novant Health, joined Jordan Messler, MD, executive director of clinical practice at Glytec, to discuss the timely importance of reimagining glycemic management during the COVID-19 era and beyond.

How Glytec Customer and Pioneering Health System Novant Health is Leading the Charge in Glycemic Management

As Dr. Rolih shared with attendees, Novant Health has provided safe, inpatient diabetes care before and during the COVID-19 pandemic in large part due to its collaborations with internal partners and external experts like Glytec clinicians. A testament to its collaborative efforts, Novant Health established and continues to build, leverage and expand multidisciplinary teams, including:

  • Diabetes Best Practice Exchange Team (BPET)-- Launched in 2016, this team was created in response to diabetes management needs and a lack of existing, uniform processes. The group promotes quality, the adoption of best practices and reduction of clinical variations, in addition to the collection, analysis and sharing of acute care data at the system and facility levels. The BPET meets monthly to identify opportunities, provide advice and implement change, working dynamically and adapting as needs evolve.
  • COVID-19+ DM Work Group --This team of 25 experts was created to optimize hospital outcomes for COVID-19 patients with diabetes. Its mandate was to identify challenges, overcome barriers and accelerate change by sharing experiences and problems, promoting best practices and crowdsourcing information internally and externally. This team also identified areas of focus for the Diabetes Best Practice Exchange Team and was later rolled into BPET. 
  • Diabetes Educator Team -- In April of 2020, the team of eight was forced to become virtual overnight and expand its role significantly. Today, the team achieves 100% coverage for Novant Health’s North Carolina hospitals and performs “glycemic surveillance” in addition to providing education.
Because of its collaborative efforts, Novant Health has been able to innovate and comprehensively advance its glycemic management with two distinct projects:
  • COVID-19+ DM Dashboard -- Partnering with an existing data analytics team, the COVID-19+ DM Work Group created a digital dashboard that continuously tracks the number and distribution of COVID-19 patients with diabetes. The dashboards include each patient’s overall mortality rate, ventilator usage and ranges for various comorbidities, among other metrics. 
  • Steroid 10-Day Pilot Study -- Based on the COVID-19+ DM Dashboard, Novant Health recognized that while high-dose steroids like Dexamethasone improved COVID patients’ odds for survival, the drug added complexity to an already ill patient population (particularly individuals with poor glucose control and diabetes). Inpatient teams desperately needed guidance for treating such patients, so Novant Health established a small workgroup with Glytec clinicians. The group produced a series of guidelines for using Glucommander, but before dispersing these guidelines, conducted a 10-day pilot study with 51 COVID-19 patients being treated with Dexamethasone. The pilot outcomes were positive: the majority of glucose values were adequately controlled, only one episode of hypoglycemia occurred and there were no deaths. Novant Health continues to refine its protocols, so the guidelines can be implemented across its entire 18-hospital system.

What’s Next for Novant Health and Glycemic ManagementInnovation

The future remains full of unknowns, however, in the coming months Novant Health will be focused on expanding the reach and role of its Diabetes Educator Team. Dr. Rolih added that her organization will continue to refine order sets and protocols, share and promote glycemic management best practices, and explore new teams and tools.

Additionally, Novant Health will incorporate three key learnings as it continues to advance glycemic management in a post-pandemic world. The first is that culture matters. As Dr. Rolih shared, Novant Health’s culture is highly patient-centric. Their success has been a result of a perpetual focus on quality and safety, and a commitment to collaboration that allows them to solve complex problems and adapt to evolving scenarios.

Dr. Rolih also stressed that teamwork is crucial. Novant Health’s ability to quickly integrate new teams of experts has been essential in successfully fulfilling patients' ever-changing needs.

Finally, Novant Health believes passion is the key ingredient. By employing passionate individuals who are willing to work above and beyond their traditional roles, Novant Health has been able to adapt and respond in times of turbulence and better prepare for future successes.

Wrapping up the webinar, Dr. Messler shared how Glytec’s eGlycemic Management System (eGMS) unites diabetes management data and teams, as demonstrated by Novant Health. With EHR and lab-integrated software, eGMS enables seamless collaboration and its cloud capabilities allow implementations and upgrades to be done remotely. Most importantly, eGMS equips teams with vital, real-time patient data so they can optimize insulin therapy, empowering organizations like Novant Health to help improve the lives of patients with glycemic issues and those administering their care.

To learn more about Novant Health’s work and how Glytec can help health systems better manage glycemia in patients, watch the entire webinar here.

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