The project “took about a year and a half before we started treating patients with it,” and initially focused on a different, though related, problem, Holder says. “When this project initially started, we were looking at ways to decrease wound infections,” he says, since there is a known correlation between infections and lack of glucose control in diabetics.
A historic impediment to improvement, however, was the widespread reliance on the traditional and yet outmoded and reactive “sliding scale” of insulin dosage based on blood glucose readings. Holder assembled a team of 23 staffers, from physicians and nurses to food service workers and a black belt in Six Sigma process improvement to develop a new and improved approach for monitoring and medicating patients.
Launched on the surgical floor in December 2010, the program was rapidly rolled out to the rest of the hospital by April. The IT end included development of a clinical decision-support tool to ensure condition-related patient data reached the physician, but also involved changes to the electronic nursing documentation, pharmacy information, glucose monitoring and room service software systems as well as requisite reporting tools.
The payoff? For an initial sampling of 75 patients, glucose levels below 180 were maintained by 81% of the patients, compared with 72% in a pre-launch baseline. The timing of glucose checks improved, too, with 80% occurring within 30 minutes of mealtime, up from a baseline of only 20%.
