Decreasing insulin induced hypoglycemia with education of a new multimodal hyperkalemia order set for patients admitted to a cancer center.

Abstract

IntroductionThis study aimed to reduce hypoglycemia by 25% in patients receiving intravenous insulin therapy for hyperkalemia through a new multimodal treatment order set. Historically, the hypoglycemia rate with the previous single-agent order set was 12.1%. Given the high-risk nature of the oncology population, even one episode of hypoglycemia can increase morbidity and negatively impact clinical outcomes.MethodsBetween October 1st and November 30th, 2023, educational materials on the new order set were presented to advanced practice practitioners, hospital physician leadership, and nursing groups. Postintervention data were collected retrospectively from December 1st, 2023, to January 22nd, 2024, using electronic health records of patients who received intravenous insulin and dextrose 50% (D50%) per the new order set. A manual chart review assessed compliance and the rate of hypoglycemia (blood glucose <70 mg/dL). Insulin dosing compliance followed weight-based dosing (0.1 units/kg, max 10 units), and D50% dosing was based on baseline point-of-care (POC) BG levels (25G if POC BG 140-250 mg/dL and 50G if <140 mg/dL).ResultsOf 125 encounters reviewed, 91 (73%) received intravenous insulin. The hypoglycemia rate was 6%, with no severe hypoglycemia (<40 mg/dL). The median baseline POC BG, creatinine clearance, and patient weight were 132.5 mg/dL, 51 mL/min, and 73 kg, respectively. All insulin doses were compliant, and 81% of D50% doses adhered to guidelines.ConclusionThe new multimodal treatment order set led to a 45.5% reduction in hypoglycemia. Provider education and standardized protocols were key in enhancing patient safety during hyperkalemia management.