Evaluation of an institution-wide guideline for hyperglycemic emergencies at a tertiary academic medical center
UMass Chan Affiliations
Department of Pharmacy PracticeDocument Type
Journal ArticlePublication Date
2013-10-01Keywords
Academic Medical CentersAdult
Diabetic Ketoacidosis
Emergencies
Female
*Guidelines as Topic
Humans
Hyperglycemia
Intensive Care Units
Length of Stay
Male
Middle Aged
Tertiary Care Centers
Emergency Medicine
Endocrine System Diseases
Endocrinology, Diabetes, and Metabolism
Health and Medical Administration
Health Services Administration
Metadata
Show full item recordAbstract
BACKGROUND: No previous studies exist examining implementation of an institution-wide guideline and order set for hyperglycemic emergencies (diabetic ketoacidosis [DKA] and hyperosmolar hyperglycemic state [HHS]). OBJECTIVE: Evaluate the impact of an institutional guideline and order set for hyperglycemic emergencies. METHODS: This retrospective descriptive study evaluated patients with a diagnosis of DKA or HHS. Two time periods were evaluated: phase 1 (PRE) assessed practice preguideline implementation, and phase 2 (POST) assessed practice postguideline and order set introduction. RESULTS: A total of 172 patients (91 PRE and 81 POST) were included in the analysis. There was no difference in the mean hospital length of stay (LOS) in the PRE versus POST groups (5.2 +/- 4 vs 5.9 +/- 8.6 days, P = .49). The mean intensive care unit (ICU) LOS was shorter in the POST group (64.8 +/- 19 vs 37.1 +/- 74.8 hours, P < .01). The POST group had an increase in frequency of assessments for clearance of urinary ketones (18 vs 33.3%, P = .03) and beta-hydroxybutyrate (16 vs 37%, P < .01). Frequency of point-of-care glucose testing (12.5 +/- 4.6 vs 15.1 +/- 4.7, P < .01) and time to anion gap closure (13 +/- 9 vs 9.3 +/- 7.4 hours, P < .01) improved in the POST group. There was no difference in the number of patients experiencing hypoglycemia or hypokalemia between both groups. CONCLUSIONS: Implementation of an institutional guideline and order set for hyperglycemic emergencies decreased ICU LOS and time to anion gap closure, with no difference in rates of hypoglycemia.Source
Ann Pharmacother. 2013 Oct;47(10):1260-5. doi: 10.1177/1060028013503111. Link to article on publisher's siteDOI
10.1177/1060028013503111Permanent Link to this Item
http://hdl.handle.net/20.500.14038/30471PubMed ID
24259689Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1177/1060028013503111