Gabriela Berlanda Ph.D. (Pharmacist, Hospital de Clínicas de Porto Alegre (HCPA) and Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil), Luiza Daniel de Souza (RN, HCPA and UFRGS), Juliana da Silva Lima MSc. (RN, HCPA), Caroline Tortato (Pharmacist, HCPA), Simone Silveira Pasin MSc. (RN, HCPA), Eloni Rotta MSc. (Pharmacist, HCPA), Melissa Hemesath MSc. (RN, HCPA), Thais Ortiz Hammes PhD. (RD, HCPA), Fernanda Rosa Indriunas Perdomini MSc. (RN, HCPA), Claudia Carolina Schnorr (MD, HCPA), Helena Barreto dos Santos PhD. (MD, HCPA), Cristiane Bauermann Leitao PhD. (MD, HCPA and Associate Professor, UFRGS), Beatriz D. Schaan PhD. (MD, HCPA and Full Professor, UFRGS. Please address correspondence to Gabriela Berlanda)
{"title":"利用改进模型降低公立三级医院住院成人患者的高血糖。","authors":"Gabriela Berlanda Ph.D. (Pharmacist, Hospital de Clínicas de Porto Alegre (HCPA) and Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil), Luiza Daniel de Souza (RN, HCPA and UFRGS), Juliana da Silva Lima MSc. (RN, HCPA), Caroline Tortato (Pharmacist, HCPA), Simone Silveira Pasin MSc. (RN, HCPA), Eloni Rotta MSc. (Pharmacist, HCPA), Melissa Hemesath MSc. (RN, HCPA), Thais Ortiz Hammes PhD. (RD, HCPA), Fernanda Rosa Indriunas Perdomini MSc. (RN, HCPA), Claudia Carolina Schnorr (MD, HCPA), Helena Barreto dos Santos PhD. (MD, HCPA), Cristiane Bauermann Leitao PhD. (MD, HCPA and Associate Professor, UFRGS), Beatriz D. Schaan PhD. (MD, HCPA and Full Professor, UFRGS. Please address correspondence to Gabriela Berlanda)","doi":"10.1016/j.jcjq.2025.01.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The objective of this study was to reduce by 50% the occurrence of average daily blood glucose (ADBG) > 180 mg/dL among noncritical patients admitted to a surgical ward at a public tertiary care hospital.</div></div><div><h3>Methods</h3><div>This project ran from April 2022 to June 2023 and used the Model for Improvement (MFI) method. Health care Failure Modes and Effects Analysis was used to identify and analyze failure modes in hyperglycemia management, and a driver diagram (DD) was used to prioritize and structure changes. The Plan-Do-Study-Act (PDSA) tool facilitated the change process. Data were collected using standardized forms and monitored with run charts, considering process, outcome, and balance indicators. The DD included 12 changes focusing on protocol implementation, adequate medical prescription, correct insulin administration, proper blood glucose monitoring, appropriate diet prescription, safe care transitions between units, routine of publication and discussion of indicators, leadership engagement with frontline workers on hyperglycemia management, educational actions, and defining roles and responsibilities.</div></div><div><h3>Results</h3><div>A 69.0% reduction in ADBG > 180 mg/dL and a 100% reduction in ADBG > 300 mg/dL were achieved, though hypoglycemic events increased from 8 to 11 per 100 patient-days using insulin or oral antidiabetic medications. Reductions in nonconformities in medical prescription and insulin administration (50.0% and 71.4%, respectively) were also achieved.</div></div><div><h3>Conclusion</h3><div>In this pilot project, use of the MFI led to improved prescription practices, insulin administration, and blood glucose control, reducing the rate of hyperglycemia in hospitalized patients.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 5","pages":"Pages 313-320"},"PeriodicalIF":2.3000,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Use of the Model for Improvement to Reduce Hyperglycemia in Adult Patients Admitted to a Public Tertiary Care Hospital\",\"authors\":\"Gabriela Berlanda Ph.D. (Pharmacist, Hospital de Clínicas de Porto Alegre (HCPA) and Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil), Luiza Daniel de Souza (RN, HCPA and UFRGS), Juliana da Silva Lima MSc. (RN, HCPA), Caroline Tortato (Pharmacist, HCPA), Simone Silveira Pasin MSc. (RN, HCPA), Eloni Rotta MSc. (Pharmacist, HCPA), Melissa Hemesath MSc. (RN, HCPA), Thais Ortiz Hammes PhD. (RD, HCPA), Fernanda Rosa Indriunas Perdomini MSc. (RN, HCPA), Claudia Carolina Schnorr (MD, HCPA), Helena Barreto dos Santos PhD. (MD, HCPA), Cristiane Bauermann Leitao PhD. (MD, HCPA and Associate Professor, UFRGS), Beatriz D. Schaan PhD. (MD, HCPA and Full Professor, UFRGS. Please address correspondence to Gabriela Berlanda)\",\"doi\":\"10.1016/j.jcjq.2025.01.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The objective of this study was to reduce by 50% the occurrence of average daily blood glucose (ADBG) > 180 mg/dL among noncritical patients admitted to a surgical ward at a public tertiary care hospital.</div></div><div><h3>Methods</h3><div>This project ran from April 2022 to June 2023 and used the Model for Improvement (MFI) method. Health care Failure Modes and Effects Analysis was used to identify and analyze failure modes in hyperglycemia management, and a driver diagram (DD) was used to prioritize and structure changes. The Plan-Do-Study-Act (PDSA) tool facilitated the change process. Data were collected using standardized forms and monitored with run charts, considering process, outcome, and balance indicators. The DD included 12 changes focusing on protocol implementation, adequate medical prescription, correct insulin administration, proper blood glucose monitoring, appropriate diet prescription, safe care transitions between units, routine of publication and discussion of indicators, leadership engagement with frontline workers on hyperglycemia management, educational actions, and defining roles and responsibilities.</div></div><div><h3>Results</h3><div>A 69.0% reduction in ADBG > 180 mg/dL and a 100% reduction in ADBG > 300 mg/dL were achieved, though hypoglycemic events increased from 8 to 11 per 100 patient-days using insulin or oral antidiabetic medications. Reductions in nonconformities in medical prescription and insulin administration (50.0% and 71.4%, respectively) were also achieved.</div></div><div><h3>Conclusion</h3><div>In this pilot project, use of the MFI led to improved prescription practices, insulin administration, and blood glucose control, reducing the rate of hyperglycemia in hospitalized patients.</div></div>\",\"PeriodicalId\":14835,\"journal\":{\"name\":\"Joint Commission journal on quality and patient safety\",\"volume\":\"51 5\",\"pages\":\"Pages 313-320\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2025-01-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Joint Commission journal on quality and patient safety\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1553725025000261\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725025000261","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Use of the Model for Improvement to Reduce Hyperglycemia in Adult Patients Admitted to a Public Tertiary Care Hospital
Background
The objective of this study was to reduce by 50% the occurrence of average daily blood glucose (ADBG) > 180 mg/dL among noncritical patients admitted to a surgical ward at a public tertiary care hospital.
Methods
This project ran from April 2022 to June 2023 and used the Model for Improvement (MFI) method. Health care Failure Modes and Effects Analysis was used to identify and analyze failure modes in hyperglycemia management, and a driver diagram (DD) was used to prioritize and structure changes. The Plan-Do-Study-Act (PDSA) tool facilitated the change process. Data were collected using standardized forms and monitored with run charts, considering process, outcome, and balance indicators. The DD included 12 changes focusing on protocol implementation, adequate medical prescription, correct insulin administration, proper blood glucose monitoring, appropriate diet prescription, safe care transitions between units, routine of publication and discussion of indicators, leadership engagement with frontline workers on hyperglycemia management, educational actions, and defining roles and responsibilities.
Results
A 69.0% reduction in ADBG > 180 mg/dL and a 100% reduction in ADBG > 300 mg/dL were achieved, though hypoglycemic events increased from 8 to 11 per 100 patient-days using insulin or oral antidiabetic medications. Reductions in nonconformities in medical prescription and insulin administration (50.0% and 71.4%, respectively) were also achieved.
Conclusion
In this pilot project, use of the MFI led to improved prescription practices, insulin administration, and blood glucose control, reducing the rate of hyperglycemia in hospitalized patients.
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