Best-in-class glycemic management programs successfully manage change and foster continuous improvement which contributes to ongoing excellence.
Every organization, however, takes a different approach to executing these programs.
During a July webinar hosted by Becker's Hospital Review and sponsored by Glytec, two experts on glycemic management discussed new technologies and how Fort Worth-based Texas Health Huguley Hospital shifted to a pharmacy-led approach to glycemic management:
- Jordan Messler, MD, CMO, Glytec
- Angela Hodges, PharmD, manager, Diabetes Center of Excellence, Texas Health Huguley Hospital in Burleson
Four key takeaways:
1. Successful glycemic management requires people, processes and technology working together. Since 2006, Glytec's mission has been to improve the lives of patients managing glycemic issues and those administering their care by optimizing insulin therapy. Glytec's eGlycemic Management System features Glucommander, an insulin management software solution that provides personalized insulin dosing decision support at the point of care. In addition, the platform offers several other modules to optimize different aspects of glycemic management. "We recognize that technology alone isn't enough for successful glycemic management. It also requires people and processes," Dr. Messler said.
2. To address glycemic management challenges in the intensive care unit, Texas Health Huguley Hospital embarked on practice change. Texas Health Huguley Hospital is a 291-bed acute care hospital that is a joint venture between Arlington-based Texas Health Resources and Altamonte Springs, Fla.-based AdventHealth. Its Diabetes Center of Excellence is a CMS five-star facility with an insulin dosing pharmacy consult service since 2011. Prior to 2018, Texas Health Huguley Hospital initiated insulin infusions in the ICU via a nurse-driven protocol. The organization also used an electronic glycemic management system. Although the emergency department and ICU nurses did a great job with these tools and processes, the previous technology solution was falling behind and the support offered by the provider was unable to meet their needs. As Dr. Hodges quoted, “Heraclitus, a Greek philosopher, is quoted as saying ‘change is the only constant in life.’"
3. The organization adopted Glytec’s eGlycemic Management System and shifted to a pharmacist-led insulin infusion initiation process. "In February 2018, we transitioned … to Glucommander IV decision support software in the ICU. At the same time, we switched from our nurse-driven process to a pharmacist-led one. In short, we made changes to our people, process and technology," Dr. Hodges said. The keys to Texas Health Huguley Hospital's success were its focus on empowered leadership, training for strategic teams, interprofessional collaboration and key process indicators and metrics. Training led to consistency and data helped overcome objections.
4. Glucometrics and other analytics underscore the program's success. In 2019, after shifting to a pharmacist-led model and implementing Glytec’s Glucommander insulin dosing decision support module, more than 80 percent of all ICU patient days at Texas Health Huguley Hospital fell into the normoglycemic range, exceeding the organization's original goal of more than 75 percent of ICU patient days in the normoglycemic range. The shift in glycemic responsibilities has also been successful. In the nurse-driven model, nurses entered 85% of orders and pharmacists were not involved in placing orders. In 2021, 74 percent of Glucommander IV entries were initiated by pharmacists, while nurses entered just 4 percent, indicating that the practice shift was successful and sustained.
"Our pharmacy-led glycemic management program has improved our efficiency, while allowing physicians to focus on other important clinical factors," Dr. Hodges said. "It also reinforced the benefit of interprofessional collaboration, expanded our pharmacists' skills and prevented clinical inertia."
To register for upcoming webinars, click here. To learn more about Glytec, click here.