The measures will also affect workers across all areas of the hospital, including dietitians, information technology, nurses, and physicians.
The Centers for Medicare and Medicaid Services (CMS) have issued new quality measures for inpatient glycemic management as part of a broader set of rules intended to increase access to treatment during the COVID-19 public health emergency and beyond.1
The new initiative requires health systems to track and publicly report rates of severe hyperglycemia, defined as the percentage of hospital days with 1 blood glucose reading greater than 300 mg/dL, excluding the first 24-hour period after admission, and severe hypoglycemia, defined as the percentage of patients having 1 blood glucose reading less than 40 mg/dl during their stay, within 24 hours of administration of insulin or other antihyperglycemic agents.
These measures will affect workers across all areas of the hospital, including dieticians, individuals who work in information technology, nurses, and physicians. Pharmacists are no exception, and these measures create an opportunity to leverage their experience with and knowledge of insulin and insulin safety to improve glycemic management efforts.
The new measures highlight 3 critical points pharmacists should keep in mind, including:
The extent to which pharmacists are involved in insulin dosing varies with each institution. It can depend on resources, such as hospital size, number of pharmacists employed, or the institution’s care model and the pharmacist’s role in that care model. For example, a small hospital might have 1 or 2 pharmacists working in the central pharmacy who are disconnected from glycemic management and focus more on medication dispensing and other operational activities. In others, the care model is much more collaborative between pharmacists and providers. Texas Health Huguley Hospital, for instance, has a pharmacy-driven culture in which pharmacists drive most of the insulin dosing.3 This also extends to the intensive care unit setting and is a prime example of pharmacists practicing at the top of their licenses.
There will never be a 1-size-fits-all approach, though. The hospital is a continuously evolving ecosystem. But hospital leadership and pharmacists must embrace these measures and realize the impact severe hypoglycemia and hyperglycemia, inappropriate insulin ordering, and insulin dosing errors have on the quality of care. In fact, the Institute for Safe Medication Practices continues to release guidelines and articles that highlight the effect of adverse glycemic events.4
Identifying the Pain Points
Pharmacists can start improving care and preparing for the CMS measures by evaluating their organization’s care model to help identify pain points in the delivery of care. It is important to ask questions such as:
By asking these types of questions, teams can identify challenges and pilot new efforts to drive change.
Other areas to keep in mind include pharmacist training needs and ongoing assessment. This may look like a crash course in diabetes and insulin management for new hires and the addition of a short annual assessment on these areas.
Finally, if they are not doing it already, institutions can also focus on creating systems to track insulin errors and rates of hyper- and hypoglycemia. Insulin errors continue to be among the most common medication errors.5 Therefore, focusing on insulin errors, especially distinguishing between hyper- and hypoglycemia, could significantly improve the quality of that care.
CMS Measures Are an Opportunity
CMS’ new quality measures underscore the critical importance of glycemic management and the increased role pharmacists can play. Pharmacists can take a greater part in providing care, whether that means adopting a pharmacy-driven approach to insulin dosing or increasing the pharmacist’s role on the care team and in glycemic management. One way is not necessarily better than the other, as long as it corresponds to an institution’s focus and resources.
This article originally appeared in Pharmacy Times.
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