Explore how our people, processes, and technology can be leveraged to address common challenges collectively.



Dave Cooper: Hi, I'm Dave Cooper. I'm a registered nurse for Glytec. I've been with Glytec for over seven years and involved in many different customer implementations. Prior to coming to Glytec, I worked in the ICU for about 10 years and used Glucommander for many of those years. Now, I'll kick it over to my colleague, Shelly Brown.

Shelley Brown: Thanks, Dave. I'm Shelly Brown, Vice President of Clinical Product Management here at Glytec. I've been with Glytec in various roles for the last 10 years and prior to that, I was a nurse in the cardiovascular step down unit and an end user of Glucommander. We're really excited to talk to you today about how you can optimize glycemic management.

Dave Cooper: Thanks, Shelly, and thank you all for joining this customer only part of our conference this year. It's been an exciting year since we last got together for Time to Target. During our session today, we want to review some of our activity over the past year. We also want to dive into some of the common challenges and opportunities that we've seen in ways that we can partner with you to overcome them.

And finally, we want to take a look into the future and give you a snapshot into things that we have planned for Glucommander.

It's been a very busy year. We've relaunched our Glucometrics platform, released our 3.5.3 version of Glucommander that provides even more end user benefits. You can also see, um, on the screen that we've done many implementations, many upgrades, and facility expansions. And many of these accomplishments will be on display across our Time to Target agenda, most notably during our first ever customer awards ceremony this afternoon at 5 p.m. Eastern Time. Be sure to tune in. We'll also be hearing from a number of our customers in tomorrow's opening session at 1 p.m. Eastern Time, and then again during the glycemic management journey session I'll be hosting at 2:25. 

One important guiding principle of ours is patient safety. In the past 12 months, we've treated more than 100,000 patients on Glucommander with over 369,000 patient days, and we've achieved a rate of 0.21 percent of patient days with severe hypoglycemia. We've also had 132 different facilities that have had zero severe hypoglycemia. Together we're improving inpatient glycemic management by bringing standardization that helps healthcare professionals and ultimately benefits the patient. But as you will hear throughout the conference, it's a journey, and we're here to partner with you on that journey.

Even though we want to highlight, even though we want to highlight some success stories, we know it's not always easy to introduce change. In my experience talking with many different organizations, something that stands out the most is that a lot of these challenges are matters of change management, whether it's overcoming complacency with the status quo or helping educate on the standards for inpatient glycemic management, it can be challenging to change.

We know there's a lot of different people in departments involved in delivering optimal glycemic management. And some of the change management elements that promote success are having that right institutional support and governance, like the need for a multidisciplinary glycemic committee. Also having the data analytics piece, the need to not only know how you're performing, but have a way to communicate that data.

And then it's also important to have that standardization and those workflows nailed down. The important one that comes to mind for me is around blood glucose check, meal tray delivery, and insulin administration, or what we refer to as the meal triad. And finally, how important the education and engagement plans are.

We know there's lots of different roles involved in glycemic management from nurses, providers, and pharmacy, and we need a plan not only to train everyone, but to get that appropriate buy-in. So, while Glucommander is designed to overcome many of the common challenges in standardized best practice, we know it's a component to a larger change management journey, and it's important to remember and have that mindset that this is a journey, a journey to optimize glycemic management.

We want to help you establish best practices at your organization, and we want to partner with you on this journey. We are here to help. My team of clinical customer success managers has lots of experience helping hospitals overcome challenges and optimize inpatient glycemic management. In addition to the support you will receive from Glytec, I wanted to walk you through some other ways and resources that we've developed to help.

Invest in people, processes, and technology. We want to support you in this journey, so we've developed different tools and resources over the past 12 months that are available to you now. Just reach out to your CCSM if you have any questions. When considering the people aspect, one of the challenges we've seen is getting staff to understand the reason or the need for the change.

We want to help you craft that vision and communicate it across your organization. So to help you tell that story, we've developed a Why Glycemic Management Matters template. This template will guide you through the key components to communicating your goals and your objectives. It starts with highlighting the current state challenges and the impact of not changing, to pointing out how this practice change in technology will help you overcome barriers.

This tool is going to help you communicate your why. We also have some internal announcement templates that can be used to help communicate, um, expansion or upgrade projects. And finally, we've created a slide deck for leadership engagement that shares a framework for improvement. It gives specific ways to think about overcoming common challenges within a change management framework that covers key areas such as governance, data analytics, workflow, and education.

We know your staff have lots of great feedback that can help you know where to focus your optimization efforts on. So, to help with this, we've created standard optimization survey templates for providers, pharmacists, and nursing staff. Using these surveys can really help you identify where education opportunities may exist.

Another opportunity is in understanding and communicating the data. One way we've invested in supporting change management is our glucometrics platform. We know that 59 percent of reporting U. S. hospitals don't have automated capability to extract and analyze glucose data. But data can help motivate not only understanding poor outcomes as the reason for the need for change, but then to understand where you are in reaching goals and where you can focus improvement efforts.

Our GlucoMetrics platform gives you access to process and outcome metrics to help you evaluate and optimize your efforts. We've rolled out a whole toolkit with instructional videos, getting starting guide, and FAQs to help you get started using, utilizing the data to facilitate change at your organization.

We'll do a deeper dive in GlucoMetrics on day two. So stay tuned. When it comes to processes, one of the biggest opportunities is education and training. Glytec has refined our training offerings based largely on feedback from thousands of learner evaluations. Seek time to complete the nursing modules has been significantly reduced in our latest modules.

For example, our IV end user and super user training modules are now 28 minutes shorter, and our SubQ versions are 44 minutes shorter. These enhanced trainings will be available to you when you upgrade. This is a sample of what's new that can be found on Glytec's eLearning website. To support your organization's ongoing training needs, we've added more standalone reinforcement assets such as more video demos and practices that can be revisited anytime outside of the eLearning modules.

We've also done things like enhance our downtime training into an easy to use format to learn how to fill out the downtime forms. This format provides information about the form, an example of a completed form, followed by a copy of the blank form. We have also realized that reaching providers with training is often very different than nurse training.

To better support this, we've enhanced our provider education strategy to support a tailored approach depending upon your hospital specific needs. Some of the ways that we support a more blended approach is by development of micro and nano learnings. We've created additional tip sheets and developed an instructor led materials for live training.

Another consistent challenge that we've seen is a lack of foundational understanding of the basics of inpatient glycemic management. Our training education support is broader than just Glucommander. To help you build that important foundation, we have an inpatient diabetes management module. This covers the basics of glycemic management in the hospital.

We also have a carb, basics of carb counting module to train nurses on carb counting. We have a new deck for providers on inpatient standards in glycemic care, as well as leveraging Glucommander to meet them. And then we also have slides that support training on the meal triad process that I mentioned earlier.

We've also seen some opportunities around supporting your superusers and nurse leaders, and we want your leaders to have the knowledge and skill for real time support and intervention for Glucommander patients. So we developed a Glucommander dashboard training that helps teach them ways to utilize the dashboard to promote a team approach in optimal patient outcomes.

We've also seen challenges for nursing staff to incorporate glycemic management as part of their shift to shift reporting and part of their daily workflow. So to help with this, we've created a shift report checklist that can be used to train on important items for nurses to communicate across shifts.

We also know how important it is to do a deep dive into specific patient cases to understand what happened, particularly causes of hypoglycemia. So to help with that, we've developed a hypoglycemia resource tool and a hypoglycemia root cause analysis tool. In partnership with our team of clinical experts, these tools will help you drive improvements at your hospital.

Of course, in addition to the people and the processes, we know there is a huge technology opportunity to help bring that standardization and improve glycemic management. This is where Glucommander can help. Our technology is based on the standards of care and allows you to approach insulin management in a consistent manner.

Glucommander SubQ specifically drives that standard basal bolus therapy. I'll pass it over to Shelly who will share more about how our technology is helping currently and how we're thinking about the future.

Shelley Brown: Thanks, Dave. How does Glycommander help overcome common challenges with typical SubQ insulin management?

Whether it's overuse of sliding scale insulin alone, lack of prandial insulin to cover carbohydrate take, inconsistent dose adjustments, or lack of precision when treating hypoglycemia, Glucommander helps address these challenges by promoting basal bolus therapy, providing daily adjustments based on glucose trends, and providing precise hypoglycemic treatment options.

Glucommander also has built in safety guard rails to prevent insulin stacking. Other common challenges with insulin management that Glucommander helps address are fixed prandial doses regardless of carbohydrate intake. Glucommander will customize meal insulin based on the carbohydrates consumed by the patient.

Correction insulin dose that is not individualized to the patient. Glucommander will individualize that correction dose based on the patient's total daily dose of insulin and insulin sensitivity. And then untreated hyperglycemia or unawareness of hyperglycemia. Glucommander will track hyperglycemia rates with real-time reports.

You can utilize GlucoSurveillance to identify patients that are at risk for hyperglycemia and need insulin management intervention. With Glucommander, we have the goal to make it easy and intuitive to use. We've talked about how insulin management is hard in the hospital, so we really want to ease the workflow of that, reduce the opportunity for error, increase the safety and efficacy, and increase nurse and provider engagement.

Um, as you are aware, we've been making iterative changes over time with our latest releases of Glucommander. We started with the 3500 series, which introduced our orders initiation and medication confirmation integrations. We also had some improved user workflows with that release, enhanced hypoglycemia treatment options with the addition of Glucagon.

With 3510, we really focus more on safety with requiring the use of the meter max feature. So for patients who had blood glucose levels above the limit, the glucose meter would read. Glucommander requires the use of that feature to provide a safety net for the patient. We also introduced the BG recovery feature that could be, um, valuable for patients that had overnight blood glucoses that were below target range that Glucommander would automatically pull those values in and the algorithm could use those for dosing adjustment.

With our 3520 release, we supported multiple time zones, made enhancements to SmartClick version 3, and then looked at our custom carb option, um, we did remove some of those options to improve the safety and standardize how patients are started on Glucommander. With 3530, we streamlined the transition workflow by providing the TDD calculation on the patient detail page for review prior to starting the transition process.

We also made enhancements to hypoglycemia by adding the option for D10, um, to be used as a hypoglycemia treatment. And then we also supported more flexible order set design, allowing for multiple order sets to be sent over through the interface and Glucommander could get those starting parameters from multiple order sets.

So that brings us to what we're doing, um, in the future. So our next release will be Glucommander 3540, and we really wanted to streamline insulin dose and order set edits with this release. We want to improve the visibility and enhance the auditability.

Specifically for the nursing workflow, we want to improve dose and order set edits, reduce the need for manual entry of those edits. For the provider workflow, we want to support flexibility of dose and order set edits and really align Glucommander ordering practices with other medications that the providers currently order in the hospital.

So diving deeper into these features, um, we're going to streamline insulin dose and order set edits by processing edits through integration. You know, currently Glucommander can consume orders to start a patient on treatment. But after the patient has started on treatment, edits have to be carried out manually by the nurse and Glucommander.

Manual entries can lead to transcription errors and missed edits, and so the patient doesn't get a provider ordered dose edit. With this set of features for 3540, we aim to eliminate the manual transcription by nurses. Glucommander will automatically receive messages for order edits through the interface.

And those messages will be processed immediately when received. Glucommander will automatically update the dose or other order set parameter on the patient detail page. And if for some reason Glucommander cannot process the edit at this time, a message will display explaining why the order could not be processed.

Going along with this set of features, um, we're looking to improve the visibility of edits. So, if we do receive an order to edit, say, a dose, for example, Glucommander is going to add in the delta icon here on the patient detail screen. In this example, you can see that the basal dose has been edited to 24 units.

You can also see that we had an edit to the dinner dose for 20 units. This will help, you know, nurses with shift change if they are curious, you know, why the breakfast bolus was 9 units and the lunch was 7 units and why is dinner now 20? Um, this will be an additional indicator here on the screen to allow the user to see that an edit did occur.

They can also look into the audit history and be able to see that information. But it is presented here for the user at a glance, so they can easily see it. Um, so here, just to further outline, underline here, you can see those edits, um, are here with those icons there. So looking at aligning the provider workflow, um, with this release, we're going to look at touching two different workflows.

Um, for the provider, looking at how insulin is initially ordered, and then also at edits. So, for providers that are ordering custom basal dosing, um, with initial ordering, if they are ordering for the basal dose to be two doses per day distribution, they have to currently order a total basal dose, and then Glucommander will then split that number into two equal doses.

With this release, um, the providers will no longer have to follow that workflow. They'll be able to specify the basal dose that will be given with each administration. So, for example, if they wanted to Um, order for the patient 20 units twice a day. They would simply order 20 units twice a day. They would no longer have to order a total basal of 40 units.

That Glucommander would then split into two equal doses. This would, um, align ordering for Glucommander with other medication practices for when providers are ordering doses, um, with multiple doses per day. Looking at the edit side of things, um, providers are going to order basal dose and distribution edits and those will be used for the next recommendation.

So whatever the provider orders, Glucommander will take that value and use it going forward. Um, we're looking at a new recommendation for order set design that will allow the providers to edit the original insulin order, whether it be the basal insulin or bolus insulin. And they would actually use that order for the modification as well.

So they again don't have to go to a workflow outside of the Glucommander order set to a Glucommander modification specific order there to make that change, just really looking to improve that workflow there. Looking at supporting flexibility of dose and order set edits, Glucommander is going to allow dose edits to occur prior to Glucommander calculating the next dose.

This would, um, be possible for both basal dose edits, so you'll be able to edit that before Glucommander has calculated the basal insulin dose, as well as bolus dose edits, um, meaning that you could always edit breakfast, lunch, and dinner at the same time. Depending on the time of the day that edit is written, you may be editing today's lunch and dinner and tomorrow's breakfast, but you would be allowed to edit all three across the board and not have to wait until Glucommander has calculated that next recommendation.

Also, there are some times that basal editing is currently locked, and so you can't make edits to the basal dose or the basal distribution, and so with this release, we're going to increase the time that basal edits are allowed, and this would be for both basal dose edits as well as order set edits, so you could also change the distribution and basal time for those doses.

While all this editing is important, being able to track what happened is also very important as well. Um, we would like to really improve messaging in the Glucommander audit history so you can fully understand what edit occurred and through what pathway that edit occurred. We're going to make the audit history messages easier to read and understand.

And then we're going to also update the description so you can determine if that edit occurred through the manual process or through integration and also if that edit occurred prior to Glucommander calculating a recommended dose. So you can see here, are some examples here. The descriptions have been updated to say the order message was processed.

That lets me know it happened through integration to edit today's basal dose from, you know, X units to X units. And then in that second option here, we edited the dose prior to system calculation. So that would be that clue there, that indicator that that dose was edited before Glucommander made that recommendation.

Tying back to our user experience goals to make Glucommander easier to use and reduce the opportunity for error, delight providers and nurses by improving satisfaction and workflows, and reduce the cost of training and support, Glucommander 3540 will make great strides to help us achieve those goals.

We've developed a strategy to help ensure that these goals are met for this release. We've engaged with professional user experience designers and researchers to help with the input on the designs for 3540. We've also performed user testing on this release using a variety of nurses, from those with no Glucommander experience to those that have used Glucommander IV and SubQ for many years.

As a part of EPIC vendor services, we were able to access and conduct testing with a hyperdrive simulator. This will help us greatly with our SmartClick v3 testing and help us provide additional insights prior to a Glucommander version being released. In addition to that, we would like to engage with customers on the design and validation of Glucommander releases.

If you are interested in partnering with us to give us feedback for our 3540 release, please reach out to your customer success manager and they'll get you in contact with the product team and we can set up those sessions. Your feedback is very important and valuable to us.

I would like to thank you for your time today joining us in our customer only session. Dave and I are really excited to kick off Time to Target. We're really excited about the agenda that's coming for you later today. 

Dave Cooper: Thank you for joining.

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