Diabetes to Go-Inpatient: Pragmatic Lessons Learned from Implementation of Technology-Enabled Diabetes Survival Skills Education Within Nursing Unit Workflow in an Urban, Tertiary Care Hospital

Initiating an Insulin Safety Campaign to reduce the incidence of glycemic harm events for hospitalized adults 65 and older

BACKGROUND

During calendar years 2021 through 2023, our health system admitted 200,837 persons 18 years and older with diabetes, of which 61% (n = 123,393) were 65 years and older with orders for insulin administration. The incidence of diabetes among hospitalized persons 65 and older continues to increase in the United States, with 24 million adults 65 and older with diabetes reported in 2020. Insulin, a high-risk medication, has the potential for adverse drug events, which can cause significant harm to patients, potentially resulting in death. With the 2023 initiation of voluntary electronic clinical quality measures reporting for severe glycemic harm events from the Centers for Medicare Services, the study team saw an opportunity to evaluate and standardize insulin-related practices across the system.

METHODS

We implemented an Insulin Safety Campaign (ISC), to review, evaluate, and standardize insulin-related processes across our health system. The primary goal was to reduce severe glycemic harm events system-wide. Insulin-related practices were reviewed for best practice alignment and standardized. Outcomes were measured according to the Centers for Medicare and Medicaid Services' electronic clinical quality measures reporting guidelines.

RESULTS

Comparing pre-and post-implementation results, all five medical centers achieved statistically significant reductions in sever hyper- and hypoglycemic harm events.

CONCLUSIONS

Through a collaborative effort, we were able to identify, address, and reduce insulin-related process variabilities through standardization, reducing the percentage of severe glycemic harm events and improving blood glucose management in our hospitalized persons 65 and older.

Hospital Diabetes Meeting 2022

The annual Virtual Hospital Diabetes Meeting was hosted by Diabetes Technology Society on April 1 and April 2, 2022. This meeting brought together experts in diabetes technology to discuss various new developments in the field of managing diabetes in hospitalized patients. Meeting topics included (1) digital health and the hospital, (2) blood glucose targets, (3) software for inpatient diabetes, (4) surgery, (5) transitions, (6) coronavirus disease and diabetes in the hospital, (7) drugs for diabetes, (8) continuous glucose monitoring, (9) quality improvement, (10) diabetes care and educatinon, and (11) uniting people, process, and technology to achieve optimal glycemic management. This meeting covered new technology that will enable better care of people with diabetes if they are hospitalized.

Implementation of South Africa's Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation

We used the Practical, Robust Implementation and Sustainability Model to evaluate implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution (CCMDD) program, a differentiated service delivery program which allows clinically stable HIV-positive patients to receive antiretroviral therapy refills at clinic- or community-based pick-up points. Across ten clinics, we conducted 109 semi-structured interviews with stakeholders (pick-up point staff, CCMDD service providers and administrators) and 16 focus groups with 138 patients. Participants had highly favorable attitudes and said CCMDD decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. Recommendations included: (1) provide patient education and improve communication around refills (at the patient level); (2) provide dedicated space and staff, and ongoing training (at the organizational/clinic level); and (3) allow for prescription renewal at pick-up points and less frequent refills, and provide feedback to clinics (at the CCMDD program level).