Medication Safety Quality Measures

Standard methods for patient ID Medication safety training Medication comparison process Look-alike and sound-alike medications Point-of-care pharmacists Diabetes management protocols Anticoagulant management protocols Chemotherapy management protocols

Quality Measures Home

Medication Safety Quality Measures

Diabetes management protocols

Insulin is the hormone that people with diabetes lack. For some people with diabetes, oral medications can be used to stimulate the pancreas (organ that produces insulin) to produce more insulin. For others, insulin must be injected in doses that reflect the body's changing need for it. Blood sugar (glucose) levels directly reflect how much insulin is needed. Diet, exercise, and stress are three factors that change the body's need for insulin.

During a hospital stay, diet, exercise, and stress levels change for most individuals, and insulin needs may also change. Improper insulin dosing can cause both high and low blood glucose levels, either of which may have serious consequences if not treated. Getting the right dose of insulin in the hospital, therefore, often requires more coordination than under normal circumstances.

Three general categories of persons who may require insulin are seen in hospitals:

1. Persons with existing diabetes
2. Persons newly diagnosed with diabetes
3. Persons who have diabetes as a temporary condition, such as some pregnant women (gestational diabetes)

According to an article endorsed by the American Diabetes Association (ADA) in Diabetes Care (2005. 28:S4-S36), hospital staff can reduce the risk of insulin errors for all patients receiving insulin by doing the following:

• Use insulin administration protocols (evidence-based formal plans for managing a disease or condition) that are responsive to changing blood glucose levels.
• Use bedside blood glucose monitoring, with results available to all members of the health care team.
• Schedule meal-time insulin doses according to bedside-monitored glucose levels.
• Have a plan for treating low blood glucose (hypoglycemia) for each patient.
• Maintain blood glucose within established parameters.
• Check Hemoglobin A1C levels (laboratory test of 120 day average blood glucose) on all persons with diabetes.
• Create an education plan including "survival skills education" and follow-up for each patient.
• Develop appropriate plans for follow-up testing for persons who fit into the category of "temporary diabetes" or hyperglycemia (high blood glucose).

St. Mary's Hospital Medical Center uses diabetes management protocols (evidence-based formal plans for managing a disease or condition) for all patients with elevated blood glucose levels.