SHM Converge Scientific Abstract ePoster Gallery-Reducing Rate of Euglycemic Dka Through Best Practiec Advisory (Bpa)

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This project evaluated a Best Practice Advisory (BPA) designed to reduce euglycemic diabetic ketoacidosis (eDKA) risk in hospitalized adults taking sodium-glucose transport protein 2 inhibitors (SGLT2i). These antidiabetic drugs have important cardiovascular and renal benefits, but they may need to be held in situations such as surgery, hypotension, reduced oral intake, declining kidney function, or urinary tract infection to avoid eDKA.<br /><br />At Morristown Medical Center, a BPA was introduced in December 2021 to prompt discontinuation of SGLT2i on admission and remind providers to restart them on discharge when appropriate. The study reviewed monthly data from January 2018 through March 2023, focusing on provider responses to the alert in adults aged 18–95 years.<br /><br />Results showed that when the BPA fired on admission, providers took action to discontinue SGLT2i medications at an average rate of 116%. On discharge, however, only 22% of providers acted on the alert to restart therapy. Overall, the BPA appeared useful for encouraging inpatient discontinuation of SGLT2i, which likely helps reduce eDKA risk, but it was much less effective for promoting appropriate resumption at discharge.<br /><br />Several limitations were noted. eDKA could not be directly tracked because it lacks an ICD code. In addition, the alert sometimes fired for all antiglycemic medications rather than only SGLT2i, which may have inflated action rates. Low discharge follow-up may reflect provider knowledge gaps or insufficient training.<br /><br />Future plans include improving the BPA workflow, educating providers on when to stop and restart SGLT2i, and refining the alert so it triggers only when SGLT2i are present in medication reconciliation.

Asset Subtitle

Rashelle Ripa

Meta Tag

Author List Rashelle Ripa, Rebecca Griffith

Category Innovations

Concept SGLT-2 Inhibitors

Concept Euglycemic Diabetic Ketoacidosis

Concept Best Practice Advisory

Concept Type 2 Diabetes Mellitus

Concept Cardiovascular Outcomes

Distinguished Non-Finalist

Presenter Organization Morristown Medical Center

Presenting Author Rashelle Ripa

Track Quality Improvement

Keywords

Best Practice Advisory

BPA

euglycemic diabetic ketoacidosis

eDKA

SGLT2 inhibitors

hospitalized adults

medication discontinuation

admission alert

discharge restart

clinical decision support

SGLT-2 Inhibitors

Euglycemic Diabetic Ketoacidosis

Best Practice Advisory

Type 2 Diabetes Mellitus

Cardiovascular Outcomes