Reducing the percentage and rate of insulin-induced hypoglycemic events is essential to improving patient outcomes and the patient experience, and plays a significant role in reducing hospital length of stay. Aiming to reduce the percentage of patient days with a hypoglycemic event, Carilion Clinic developed a programmatic approach to improving and monitoring performance related to insulin prescribing and administration based on clinical and technological best practices.
Program Details
The education and performance improvement scope included goals to increase utilization of the insulin sensitivity factor calculator, increase utilization of hypoglycemia protocols, and reeducate on intravenous to subcutaneous insulin transition protocols. In addition, educators facilitated a multidisciplinary team change management strategy for frontline staff.
Training was delivered utilizing multiple methodologies to meet the unique needs of Carilion’s direct patient care teams who represent a diverse group of clinical roles, including pharmacists, dieticians, nurses, physicians, clinical advancement and patient safety facilitators, and operative and invasive procedure teams. Based on role and scope of practice, clinicians received education through a combination of the following methodologies:
- Insulin-ordering and administration microlearning guides embedded in the electronic health record to maximize just-in-time accessibility
- Scenario lab sessions for multidisciplinary teams to participate in simulation exercises
- At-the-elbow field support from technology educators and clinical performance improvement facilitators
- 24/7 educator support through a virtual training platform
In addition, daily stand-up meetings provide unit leaders with the opportunity to discuss events in real time and receive best practice guidance from the interdisciplinary team. Performance improvement facilitators and technology trainers also continue to complete regularly scheduled rounding in each nursing unit to emphasize best practices and review known events.
Results
Across the system, approximately 60 percent of the workforce participated in the training, representing five Carilion hospitals and an inpatient acute rehab center.
Since October 2022, Carilion has increased monthly insulin protocol utilization by 10.4 percent, and the three-month moving average increased by 6.97 percent. Since October 2022, Carilion also has decreased the percentage of patient days with a hypoglycemic event by .34 percent, and hospital length of stay has decreased by .6 days.
