It’s no secret health systems have grappled with unprecedented challenges in the last few years – from a global pandemic to staffing shortages, burnout, budget constraints and more. Amidst these challenges, providers have been hyper-focused on maintaining patient safety and quality care. It's no wonder new technology initiatives and workflow improvements were often put on hold. But what if staying within the status quo is negatively impacting patient care?
Take glycemic management, for instance. Roughly 30% of hospitalized patients, up to 40% of surgical patients, and 80% of cardiac surgery patients experience hyperglycemia in the hospital and require insulin to get their blood sugars back in range.
Hospital staff struggle because of outdated IV insulin paper protocols which require manual calculations for titrating insulin, limited access to inpatient diabetes experts, a time-consuming process, and fear of administering too much insulin. While purpose-built technology exists to address these challenges, clinical inertia generally prevails, and IT teams are often hesitant to implement a new piece of software in a growing technology stack.
However, the industry is finally taking notice of the lack of evidence-based and individualized care in glycemic management. The time to reduce hypoglycemia with a technology-driven approach to insulin is today – especially in the emergency department, ICU and step-down units.
The Glycemic Management Revolution
Members of the diabetes community have been sharing the risks related to poor inpatient glycemic management for years, including adverse medical events, extended length of stay, increased risk of infection, readmission, and increased rates of other conditions, such as heart disease.
In 2021, the Centers for Medicare and Medicaid Services (CMS) acknowledged this often overlooked area of inpatient care by announcing new quality reporting measures for reducing rates of hypo- and hyperglycemia in the hospital setting. With this news, CMS sends a clear message to health systems; glycemic metrics are an important marker of patient safety standards in the hospital. The measures have skyrocketed glycemic management initiatives to the top of the priority list for senior hospital officials.
Other advocacy groups have gone even further. According to the American Diabetes Association (ADA) 2022 Standards of Medical Care in Diabetes, continuous intravenous insulin infusion in the critical care setting is the most effective method for achieving glycemic targets. In addition, IV insulin infusions should be administered based on validated written or computerized protocols that allow for predefined adjustments in the infusion rate, accounting for glycemic fluctuations and insulin dose.
Despite these recommendations, many hospitals still rely on outdated sliding scale, paper protocols or digitized calculators for insulin dosing, some of which were first used in 1930’s. Medicine has changed since then, and it's time for a new way to think about glycemic management.
eGlycemic Management System ® Charts the Future of Insulin Dosing
In lieu of traditional manual paper protocols or sliding scale methods, Glytec’s eGlycemic Management System (eGMS®) centers on Glucommander – an FDA-cleared insulin dosing software. It provides personalized insulin dosing decision support at the point of care while guiding clinicians through best practice workflows. Beyond dosing, Glytec’s eGMS provides three major areas of expertise that were developed to help prevent adverse medical events related to insulin administration, including glycemic analytics and reporting, surveillance to identify at-risk patients and workflow alerts for patient monitoring.
The good news for IT departments is that eGMS can help hospitals leverage their existing EHR investments, since eGMS® integrates seamlessly with EHRs using HL7 v2.x, allowing clinicians to receive ADT and LIS information from the EHR that updates Glytec’s eGMS, specifically, Glucommander’s software. In addition, the cloud-based technology enables teams to take a quick-start approach to improve glycemic management and helps IT teams integrate and deploy in as little as 8 weeks requiring only 40 hours of development time from 3 key roles. In addition to a standardized implementation process hospitals receive easy onboarding and role-specific support, training and education for IT and clinical teams. IT teams can also rest easy knowing eGMS® is the only HITRUST-certified solution on the market.
And the results speak for themselves. Glytec’s eGMS’s safety guardrails have helped reduce preventable severe hypo events by 62% when compared to the hospital’s previous software solution and a 99.8% reduction in the frequency of severe hypoglycemia when compared to a paper-based protocol. Additionally, clinical results show mild to moderate DKA patients can reach target range on average in 5 hours, validating the solution’s ability to safely and quickly resolve DKA.
As health systems work to evolve their current insulin dosing procedures to align with ADA recommendations and meet the CMS measures, one hospital can attest to the power of a technology-informed approach to IV insulin.
Technology Titration in Action
Grady Hospital, a community-based academic medical center with 640 beds, deployed Glytec’s eGMS for use in their ICUs and step-down units. Over two years, Grady compared glycemic control between patients whose insulin infusions were managed with eGMS® to patients whose insulin infusions were managed with standard protocols. Among 2,897 patients, 926 (32%) were managed with eGMS® and 1,971 (68%) were managed with legacy care.
According to the study, eGMS use was superior in improving glycemic control of critical care patients. With eGMS, Grady saw a 99.8% reduction in the frequency of hypoglycemia in critically ill patients and a 75% reduction in moderate hypoglycemia in critically ill patients.
Research on the effect of glycemic management on hospital patients has been well-studied for decades. With CMS’s latest quality measures, government officials are insisting that hospitals have a duty to their patients and staff to provide a technology-informed approach to IV insulin today. To provide a patient safety-centered approach to insulin dosing, health systems must evolve and find a solution that integrates all aspects of a care team. With Glytec’s eGMS, dysglycemia doesn’t have to be the norm.
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