Using a mentoring approach to implement an inpatient glycemic control program in United States hospitals

Robert J Rushakoff; Mary M Sullivan; Jane Jeffrie Seley; Archana Sadhu; Cheryl W O'Malley; Carol Manchester; Eric Peterson; Kendall M Rogers

doi:10.1016/j.hjdsi.2014.06.004

Using a mentoring approach to implement an inpatient glycemic control program in United States hospitals

Healthc (Amst). 2014 Sep;2(3):205-10. doi: 10.1016/j.hjdsi.2014.06.004. Epub 2014 Jul 22.

Authors

Robert J Rushakoff¹, Mary M Sullivan², Jane Jeffrie Seley³, Archana Sadhu⁴, Cheryl W O'Malley⁵, Carol Manchester⁶, Eric Peterson⁷, Kendall M Rogers⁸

Affiliations

¹ Division of Endocrinology and Metabolism, University of California, San Francisco, 1600 Divisadero Street, Room C430, San Francisco, CA 94115, United States. Electronic address: robert.rushakoff@ucsf.edu.
² Department of Nursing, University of California, 1600 Divisadero Street, Room C430, San Francisco, CA 94115, United States.
³ NewYork-Presbyterian/Weill Cornell, 525 East 68 Street, Room F2025, New York, NY 10065, United States.
⁴ Methodist Academic Medicine Associates, 6550 Fannin Street, Smith Tower #1101, Houston, TX 77030, United States.
⁵ University of Arizona College of Medicine, Banner Good Samaritan Medical Center - LL2, 1111 E. McDowell Road, Phoenix, AZ 85006, United States.
⁶ University of Minnesota Medical Center, Eagan, MN 55122-2290, United States.
⁷ Performance Improvement CME, American Academy of Physician Assistants, 2318 Mill Road, Suite 1300, Alexandria, VA 22314-6868, United States.
⁸ Department of Internal Medicine, University of New Mexico School of Medicine, MSC10 5550, 1 University of New Mexico, Albuquerque, NM 87131, United States.

PMID: 26250508
DOI: 10.1016/j.hjdsi.2014.06.004

Abstract

Background: establishing an inpatient glycemic control program is challenging, requires years of work, significant education and coordination of medical, nursing, dietary, and pharmacy staff, and support from administration and Performance Improvement departments. We undertook a 2 year quality improvement project assisting 10 medical centers (academic and community) across the US to implement inpatient glycemic control programs.

Methods: the project was comprised of 3 interventions. (1) One day site visit with a faculty team (MD and CDE) to meet with key personnel, identify deficiencies and barriers to change, set site specific goals and develop strategies and timelines for performance improvement. (2) Three webinar follow-up sessions. (3) Web site for educational resources. Updates, challenges, and accomplishments for each site were reviewed at the time of each webinar and progress measured at the completion of the project with an evaluation questionnaire.

Results: as a result of our intervention, institutions revised and simplified formularies and insulin order sets (with CHO counting options); implemented glucometrics and CDE monitoring of inpatient glucoses (assisting providers with orders); added new protocols for DKA and perinatal treatment; and implemented nursing, physician and patient education initiatives. Changes were institution specific, fitting the local needs and cultures. As to the extent to which Institution׳s goals were satisfied: 2 reported "completely", 4 "mostly," 3 "partially," and 1 "marginally". Institutions continue to move toward fulfilling their goals.

Conclusions: an individualized, structured, performance improvement approach with expert faculty mentors can help facilitate change in an institution dedicated to implementing an inpatient glycemic control program.

Keywords: Hospital diabetes; Inpatient diabetes; Inpatient glucose; Inpatient glycemic management; Inpatient insulin management; quality improvement mentorship.