SHM Converge Scientific Abstract ePoster Gallery-Fighting the Lows: Pharmacist-Directed Mitigation Strategies to Decrease Hypoglycemic Events in a Hospital Setting

Pdf Summary

This project evaluated whether pharmacist-directed insulin dose adjustments could reduce inpatient hypoglycemic events at Emory Saint Joseph’s Hospital (ESJH) and Emory University Hospital Midtown (EUHM) after an increase in Vizient-reported low blood glucose events following the transition to Epic.<br /><br />Internal review showed hypoglycemia was more common on acute care units than in critical care, especially among patients with chronic kidney disease or end-stage renal disease. Most patients who experienced hypoglycemia had relatively low recent glucose values: 78% had a blood glucose under 100 mg/dL within 24 hours, and 84% within 48 hours before the event. The review also found there was no formal process to flag high-risk patients, and providers had limited guidance for adjusting insulin in already treated patients.<br /><br />A pilot intervention was implemented using real-time Epic reports to identify patients on subcutaneous insulin with blood glucose under 100 mg/dL. Pharmacists reviewed contributing factors such as diet changes, steroid use, and insulin orders, then recommended dose reductions, holds, or discontinuation when appropriate. The pilot ran during weekday pharmacist coverage hours and focused on selected acute care units at ESJH.<br /><br />A total of 110 pharmacist interventions were made post-implementation. Of these, 74% were accepted as recommended, 27% were accepted with modification, and only one was rejected. Average glucose rose from 83 mg/dL before intervention to 123 mg/dL 24 hours later.<br /><br />Compared with the pre-intervention period, hypoglycemic events decreased by 28% at ESJH (33 vs. 46) and by 52.5% at EUHM (23 vs. 40). Over half of reported events occurred on weekends, when the clinical specialist pharmacist was not present, suggesting a potential gap for future coverage improvements. The project demonstrated that pharmacist involvement can help prevent inpatient hypoglycemia and supports broader implementation, including a future clinical scoring tool in Epic.

Asset Subtitle

Patricia Hwang

Meta Tag

Author List Amanda Van Prooyen, Angelita Incer, Patricia Hwang

Category Innovations

Concept Inpatient Hypoglycemia

Concept Blood Glucose

Concept Insulin Therapy

Concept Patient Safety

Concept Subcutaneous Insulin

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine/ Division of Hospital Medicine

Presenting Author Patricia Hwang

Track Quality Improvement

Keywords

pharmacist-directed insulin adjustment

inpatient hypoglycemia

Epic reports

blood glucose monitoring

acute care units

subcutaneous insulin

dose reduction

chronic kidney disease

end-stage renal disease

Vizient low blood glucose events

Inpatient Hypoglycemia

Blood Glucose

Insulin Therapy

Patient Safety

Subcutaneous Insulin