|Inpatient Diabetes Management Team|
Sherita Hill Golden, MD, MHS
Director, Inpatient Diabetes Management Service
Chairperson, Glucose Steering Committee
Theresa Kemmerer, RN, MSN, APN, CDE
Nurse Practitioner, Inpatient Diabetes Management Service
Clinical Facilitator, Glucose Steering Committee
Holly Bashura RN, MS, CRNP, CDE
Nurse Practitioner, Inpatient Diabetes Management Services
Veronica Sanchez, MSN, BSN, RN
Quality Improvement Team Leader
The Johns Hopkins Inpatient Diabetes Management Service (IDMS) was implemented on July 1, 2003 as a pilot diabetes clinical consultation service to improved glucose control and reduce length of stay in diabetes patients undergoing cardiac surgery. During the first year of the program, length of stay on cardiac surgery patients with diabetes seen by our service was reduced by 58%. We subsequently expanded to other clinical services throughout the hospital. In January 2006, a hospital-wide Glucose Control Task Force (GCTF) was commissioned in response to a sentinel event related to hypoglycemia and our clinical service became an integral component of the hospital-wide GCTF. Because of on-going need for diabetes policy development, education, and safety monitoring, the GCTF evolved into a standing Glucose Management Committee (GMC) in July 2008 and into the Glucose Steering Committee in July 2010.
Together, the IDMS and Glucose Steering Committee comprise the Johns Hopkins Glucose Management Program. The goals of this program are as follows:
1) To perform inpatient diabetes consultations and respond promptly and effectively to improve glycemic control among inpatients with diabetes on adult medical and surgical services. Our clinical services are currently focused on several complex patient populations that require our support—cardiac surgery, transplant surgery, pancreatectomy, and insulin pump patients.
2) To expand the inpatient diabetes management service to include diabetes inpatients admitted to additional medical and surgical services and to include acute care and intermediate care units to assist with management of insulin infusion protocols and transitioning patients from insulin infusions to subcutaneous insulin.
3) To support the activities of the Johns Hopkins Glucose Management Committee to promote better glycemic control in a safe and effective manner through the following activities:
a.) Improve safe coordination of diabetes care throughout the hospital by development and implementation of a standardized, hospital-wide insulin orderset (written and POE) and additional glucose management policies.
b.) Reduce severe hypoglycemic episodes by implementation of a hospital-wide hypoglycemia protocol
c.) Develop uniform insulin infusion protocols throughout the critical care units in the hospital with uniform incorporation of hypoglycemia treatment
d.) Improve institutional diabetes education through distribution of a web-based diabetes educational resource and a diabetes nursing and physician superuser program.
4) To develop a team approach, in conjunction with the Glucose Management Committee, to investigate and respond to glucose-related safety mishaps within one week and to generate a report and preventive policy plan within one month.
5) To monitor the effectiveness of our interventions by exploiting hospital-wide glucose measurement data and insulin prescribing information from our Physician Order Entry (POE) System.
Inpatient Diabetes Management Prescriber Tools:
- Total Daily Insulin Dose And Johns Hopkins Hospital Formulary Insulins
- Stepwise Approach To Initial Management of Inpatient Hyperglycemia
- Adjusting Inpatient SQ Insulin
- Determining Correction Dose of SQ Aspart Insulin For BG >350 MG/DL
- Protocol For Managemnt of Adult Patients with DKA or HHS
- Non-Insulin Antidiabetic Agents
- Insulin Pumps in the Hospital
- Transitiong to a Home Regimen for Patients with Hyperglycemia Druing Hospitalization