Pharmacy Focus Podcast Episode 49

In by Alexa Driscoll


Pharmacy Focus Podcast Episode 49

Inpatient Insulin Management from the Pharmacy Perspective

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Stephanie Ostling Mason, PharmD, CDCES, Diabetes Clinical Pharmacist at Glytec was invited as a pharmacy champion to be interviewed for the Pharmacy Focus Podcast. Her episode details the importance of inpatient insulin management from the pharmacy perspective and how pharmacists can work to reduce instances of severe hypoglycemia and severe hyperglycemia. 

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Joe Murphy: Hi, this is Joe Murphy from pharmacy times, and you are listening to pharmacy focus. The pharmacy times pharmacy focus podcast provides the latest industry news and information thought. Leader insights, clinical updates, patient counseling tools, and innovative solutions for the everyday practice and business of pharmacy.

Before we begin with this week's episode. Do you know what formula the medieval chemists believe could unlock immortality? We will reveal the answer at the end of the episode. In this week's episode, we will be discussing the importance of inpatient insulin management from the pharmacy perspective with Stephanie Mason, pharmacists and certified diabetes care and education specialists.

Mason is diagnosed with diabetes herself, which is why this area of study and the new quality measures from CMS about hypo and hyperglycemia were so monumental to her in the pharmacy field.

Stephanie Mason: Certainly been a lot of talk around the CMS measures since they came out in, uh, August of, of 2021. And the two that are, um, most relevant to inpatient glycemic management are severe hyperglycemia and severe hypoglycemia.

Um, severe hyperglycemia is defined as the percentage of hospital days with one blood glucose reading greater than 300 milligrams per deciliter. Excluding that first 24 hours after admission and severe hypoglycemia is defined as the percentage of patients having one blood glucose, less than 40 during their hospital stay.

And that blood glucose must occur within 24 hours of the administration of insulin or other antihyperglycemic agent. So those are the, in a, in a nutshell, um, The, um, two measures from CMS, but, but really why is this so important? And, and why are we talking about this so much? Well, diabetes and hyperglycemia in the hospital is not a new thing.

Um, you know, there's a paper from, I believe it's 2002 published in the journal of clinical end, endocrinology and metabolism. And even at that time, which I recognize is, you know, 20. 20 years ago. Um, it estimated 38% of hospitalized patients had hyperglycemia and of those 26% had a history of diabetes and 12% had, uh, stress hyperglycemia.

Now, I don't know what those numbers are exactly today, but, um, I think it's safe to say they're, they're not any lower. And of course they'll vary, um, by region and patient population. Um, but I think the bottom line. We still are seeing people with diabetes in the hospital. We are still seeing hyperglycemia in the hospital.

Um, I think even COVID has just, uh, really emphasized, um, the, the prevalence of diabetes and hyperglycemia in the hospital, but we haven't necessarily been seeing a, a dramatic. Shift in how we're managing these patients. And so why this is so monumental is because is because finally CMS is coming out and saying that glycemic management matters.

It cannot continue to be an afterthought or on the back burner. Um, I know a lot of hospitals oftentimes focus on reducing hypoglycemia and of course, Critically important and you have to start somewhere, but CMS is coming out and saying, it's not just hypoglycemia that we need to be concerned about.

It's also hyperglycemia. And so I think that's really why. This is so important. And I know there are so many of us in diabetes that always feel like we're, we're having to scream for people to listen to us and pay attention to diabetes and glycemic management in the hospital. Um, and so these CMS measures are really, uh, Pushing that forward, um, and drawing a lot more attention, uh, to, to this.

And so that's, that's huge.

Joe Murphy: She continues to explain how important this is for pharmacists due to their integral role on care teams and their involvement to improve care.

Stephanie Mason: You know, these CMS measures, these are going to be things that, you know, hospitals are having to track and report. And so what that means is it's a responsibility ultimately, you know, on care teams. And I think we all consider the pharmacist, you know, as a very integral member of those care teams. And so they will certainly be impacted, um, by these new CMS, uh, CMS measures. Um, So, and, you know, we can talk a little bit more about what that pharmacist's role might look like. Um, but certainly the pharmacists are going to be involved in these efforts to improve care and care delivery, um, for patients with diabetes and in hyperglycemia, uh, in the hospital.

Joe Murphy: We are taking a short break to celebrate the pharmacy heroes who work at Boone drugs Inc. In North Carolina, which is over 100 years old and has 17 locations during the peak of the COVID 19 pandemic, the pharmacies have offered free county-wide delivery and curbside pickup at many locations all while keeping their staff and patients safe.

If you would like to nominate a pharmacist or pharmacy staff member as a pharmacy hero, email the address in our description with your nominee. Now, back to the show. Mason continued to explain that when she thinks of glycemic management and diabetes, she feels that insulin is a core opportunity for pharmacists to get involved.

Stephanie Mason: You know, insulin, I believe still to this day. Um, you know, I'm sure is M P probably has, you know, some numbers on this, but, you know, insulin. Still, uh, very common. Um, you know, one of the top medical or medication errors in the hospital today and pharmacists, I really think have, um, two different opportunities with.

With improving the safety and efficacy of insulin in the hospital. Um, one is from more of a, maybe an operational perspective, I guess you could say. And so I'm kind of thinking about the central pharmacy environment, you know, making sure we're grabbing the right insulin, we're drawing up, um, the right concentration.

If the pharmacy, you know, was doing that, um, reducing those types of errors and then on the other side, um, it's, it's this very, um, Patient care, um, type of approach. And what I mean by that is, um, now it's, it's working with the care teams to, um, determine what is that initial basal dose that we should give this patient, or what are those mealtime doses, um, that, that are appropriate for this patient?

Um, Based on the blood sugar trends we're seeing, how should we adjust those insulin doses? And so I think there are, um, several opportunities for pharmacists to really get engaged. Um, and insulin is a, is a great place. Um, To start because it's, it's a medication. And of course we, pharmacists are, are those medication experts.

Joe Murphy: as for the future of this topic, she believes that pharmacists should expect their involvement in glycemic management to increase.

Stephanie Mason: You know, I recognize that the, the pharmacy practice model is going to vary from institution to institution. Um, I see that every day in, in the work that I'm doing, working with clients, you know, across the country, um, nobody has the exact same pharmacy model. And so. What I would encourage pharmacists to do. And pharmacy leaders to do is really evaluate their, their current practice. You know, what are the things that they are already doing well? Where are there gaps, um, in that care delivery process for patients with diabetes and hyperglycemia and. What, you know, where can pharmacists really fill in? Um, how can we maximize, you know, the expertise of the pharmacist and the role of the pharmacist?

And so I think having very intentional and focused conversations, um, is, is certainly a place to start because at the end of the day, we know. Change is going to have to happen because CMS has just, you know, made that announcement. And so, um, pharmacists kind of, you know, starting to think now those pharmacy teams of what changes are coming down the pipeline and how can we really, um, do things effectively, um, Is is certainly a conversation we should be having now. Um, and I can speak to that a little bit, a little bit more of just some of the examples that I've seen, if that would be helpful.

Joe Murphy: Thanks for listening to pharmacy focus, stay tuned for next episode where we will be joined by another key opinion leader in the pharmacy space.

This podcast originally appeared on Pharmacy Focus Podcast.

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