Nurs Res. 2020 Sep 24. doi: 10.1097/NNR.0000000000000478. Online ahead of print.
BACKGROUND: Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality.
OBJECTIVES: This was a retrospective pre-post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention; timeliness of adherence to the hypoglycemia protocol; the number of treatment interventions; and time to return patients to euglycemia were analyzed.
METHODS: Data from hospitalizations of patients who experienced hypoglycemia (< 70 mg/dL) and met inclusion criteria 1 year prior to and 3 years postintervention were extracted including demographics, glycemic control medications, diagnostic-related group, length of stay, and Charlson Comorbidity Index (CCI). For clarity and to determine if any significant change was sustained, the analysis compared data from 1 year prior to the second-year postintervention.
RESULTS: A total of 7,895 unique hypoglycemic events in 3,819 patients experiencing 20,094 hypoglycemic measures were included in the analysis. Patients were primarily adult, female, and White. Only 58.7% of the sample had diabetes; the median CCI was 6. Results demonstrated improvement postintervention to RN hypoglycemia protocol adherence regardless of age category or hypoglycemia severity. There was a significant reduction in median time from first hypoglycemia measure to second measure. In addition, there was a significant difference in the number of treatment interventions and reduction in time from first hypoglycemia measure to return of patient to a blood glucose > 70 mg/dL.
DISCUSSION: These study results support that the use of a standardized hypoglycemia protocol and appropriate nurse workflows enable nurses to manage hypoglycemia promptly and effectively in the majority of acute and critically ill hospitalized patients. Results also supported a differentiation in nurse workflow for patients with mild versus severe hypoglycemia. Implementing these interventions may result in avoidance or mitigation of the potential consequences of severe and/or sustained hypoglycemia.