J Am Pharm Assoc (2003). 2023 Sep 9:S1544-3191(23)00294-7. doi: 10.1016/j.japh.2023.09.002. Online ahead of print.
BACKGROUND: Inpatient hypoglycemia is associated with increased morbidity and mortality. After a hypoglycemic event, the likelihood of additional episodes increases. The Joint Commission recommends evaluating all episodes of hypoglycemia for root-cause analysis. Studies have shown that pharmacists' involvement with glycemic control protocols can prevent hypoglycemia.
OBJECTIVES: To assess whether the implementation of pharmacists' real-time assessment of hypoglycemic events using an electronic alert messaging system contributes to the reduction of the number of recurrent hypoglycemia during hospitalization.
PRACTICE DESCRIPTION: A community hospital that provides a wide range of healthcare services. The pharmacy department provides fully decentralized clinical services as well as team-based specialist services.
PRACTICE INNOVATION: The pharmacist-led hypoglycemia stewardship initiative included a comprehensive review of hypoglycemic alerts received via an automated message. The alerts generated in the EHR every time a patient's blood glucose resulted in less than 70mg/dL if there was a documented administration of a hypoglycemic agent 48 hours prior to the hypoglycemia event. Once the alert was received by the pharmacists via an EHR in-basket, a real time review was conducted to identify the potential causes of the event and opportunities for therapy modification.
EVALUATION METHODS: A single-center retrospective observational study including a pre and post-implementation phase from January 1st to June 30th, 2020 and January 1st to June 30th, 2021 respectively. Continuous data was analyzed using paired and equal variance t-test. Non-continuous data was analyzed using Fischer exact and chi-square test. Descriptive statistics were used to describe distribution and frequency of data.
RESULTS: There was a 5.1% absolute reduction in recurrent hypoglycemic events (p<0.001) and a 0.6% reduction of severe hypoglycemic days (p=0.269 in the post-implementation group). The average time to pharmacist intervention was 4 (+ 3.5) hours with a 92% acceptance rate.
CONCLUSION: This study demonstrated the utility of pharmacist-led hypoglycemia reviews in the reduction of recurrent hypoglycemic events in the inpatient setting.