30 Reducing iatrogenic low blood glucose episodes during hospital management of pediatric diabetic ketoacidosis. (25th November 2019)

• Record Type: Journal Article
• Authors: Baumer-Mouradian, Shannon; Servi, Ashley; Gage, Pam; Huitink, Sandy; Sprague, Rebecca; Ligget, Jeremy; Wolfgram, Peter
• Is Part Of: BMJ open quality. Volume 8:Supplement 2(2019)
• Page Start: A46
• Page End: A47
• Publication Date: 2019-11-25
• Subjects: Medical care -- Quality control -- Periodicals; 362.106805
• DOI: 10.1136/bmjoq-2019-ihi.30
• Languages: English
• ISSNs: 2399-6641

Abstract

Abstract : Background: IV insulin therapy, the treatment for pediatric diabetic ketoacidosis (DKA), may lead to iatrogenic low blood glucose episodes (BG <100 mg/dL). At our institution, 53% of DKA patients on IV insulin experienced BG <100 mg/dL episode resulting in premature discontinuation of insulin and delays in therapy. Objectives: We aimed to decrease the percent of DKA patients experiencing BG <100 mg/dL episodes while on IV insulin from 53% to 43% over 24 months. Methods: Multiple interventions linked to key drivers were tested using plan-do-study-act cycles including a standardized DKA guideline incorporating the two-bag fluid system, order panels, frequent blood glucose monitoring, and provider and nursing education. The primary outcome was the percent of DKA patients experiencing a BG <100 mg/dL episode while on IV insulin. Order panel utilization rate was the process measure. Balancing measures included length of stay, time to correction of acidosis (time to HCO 3>17), and admission rates. All outcomes were analyzed on statistical process control charts. Results: From January 2017 through August 2019, 334 patients had confirmed DKA (bicarbonate level <15) and received IV insulin therapy in the ED or on the acute care unit. Following our interventions, the number of patients experiencing a low blood glucose level improved from 53% to 42% (figure 1 ). Order panel utilization rate remained at 96%. There was no change in our balancing measures. Conclusions: Use of QI methodology and standardized DKA management resulted in a meaningful reduction in the number of patients with a BG<100 mg/dL episode while on IV insulin.