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Data visualization, automated tools improve inpatient glycemic management
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NEW ORLEANS – The use of automated tools in patient electronic medical records along with institution-specific guidelines can help clinicians reduce both insulin dosing and insulin-type errors in adults with diabetes, according to a speaker here.
Implementing best practices for inpatient glycemic management remains a mystery for many hospitals struggling to change the culture from sliding-scale insulin therapy to the more physiological basal/bolus insulin therapy, said Jane Jeffrie Seley, DNP, MPH, BC-ADM, CDE, a diabetes nurse practitioner at New York Presbyterian Hospital and Weill Cornell Medical College. Computerized, comprehensive insulin order sets with built-in decision support tools facilitate both smarter insulin initiation and titration, Seley said.
Jane Jeffrie Seley
“Pre-selection of orders for blood glucose monitoring, hypoglycemia treatment, a consistent carbohydrate meal plan, diabetes education and insulin starting doses prevents omission of these orders,” Seley told Endocrine Today. “Developing institution-specific clinical practice guidelines helps the prescriber address challenging situations such as patients on steroids and enteral feedings.”
Seley has seen the results in practice, she said. At her institution, implementing the Data Vis decision support tool has helped clinicians identify patterns of both hypoglycemia and hyperglycemia and adjust the right insulin, she said.
“The implementation of Data Vis for glycemic control at New York Presbyterian Hospital has saved the endocrine fellows at the Cornell Campus where I work several hours daily, since they no longer need to transcribe blood glucose results and corresponding insulin doses onto a flow sheet to identify patterns,” Seley said.
Seley said that house staff, nurse practitioners, physician assistants and nurses are incorporating Data Vis into their work flow and learning how to identify patterns of highs and lows.
“In the end, I am hoping this tool will reduce hypoglycemia and clinical inertia by promoting timely titration of insulin,” Seley said. “I encourage CDEs to go back to their institutions and assist in the development of specific clinical practice guidelines and educational modules to support the implementation of these guidelines.” – by Regina Schaffer
Reference:
Seley, Jane Jeffrie. W13. Presented at: The American Association of Diabetes Educators Annual Meeting 2015; August 5-8; New Orleans.
Disclosure: Seley reports serving on the advisory board for Bayer Diabetes Care, Novo Nordisk and Sanofi Diabetes.