Implementation and Evaluation of an Inpatient Diabetes Superuser Education Program

Johns Hopkins University, Baltimore MD

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Abstract

? DESCRIPTION (provided by applicant): Both hyperglycemia and hypoglycemia n the hospital are associated with various adverse outcomes, including increased complications, length of stay, cost, and mortality. To address this issue, Johns Hopkins Hospital (JHH) established an Inpatient Glucose Management Program in 2006 to address hypoglycemia and hyperglycemia and to ensure safe, standardized care delivery for hospitalized patients with diabetes. To support nursing education and compliance with JHH glucose management policies, the diabetes nursing super user program was initiated in January 2007 and was critical to implementing the hypoglycemia policy nursing interventions. Following the establishment of hospital-wide glucose management policies and order sets for hypoglycemia and hyperglycemia, the nursing diabetes super user education program, and clinical decision support tools for prescribers, there was a significant and sustained reduction in the incidence of hypoglycemia (~20%) over a 3-year time period. However, the incidence of severe hyperglycemia was not significantly reduced by these interventions, indicating a differential impact of the program on hyperglycemia compared to hypoglycemia. We believe this disparity is due to the hypoglycemia policy being implemented by the nursing staff, whereas the hyperglycemia policy and order set are implemented by prescribers (e.g., house staff and hospitalists). Given our nursing program's success in contributing to sustained reduction in hypoglycemia, we hypothesize that an analogous diabetes prescriber super user program, targeting physicians, will be an effective educational approach to addressing persistent hyperglycemia. Our proposal is responsive to PAR-13-367 in several ways-(1) it seeks to improve diabetes treatment in the hospital, a routine and relevant healthcare setting and (2) it utilizes existing healthcare infrastructure integrated into all hospitals-nursing staff and physicians-making it practical, scalable, and sustainable in other health systems. We have the following specific aims: (1) to develop the diabetes prescriber super user educational curriculum through Johns Hopkins Health System (JHHS) stakeholder community engagement; (2) to refine and package the JHH diabetes nursing and prescriber super user educational curricula into an electronic tool kit and disseminate it locally to the 3 JHHS hospitals, based on stakeholder feedback; and (3) to evaluate the impact of implementing the JHH diabetes nursing and prescriber super user programs at 3 JHHS hospitals on glycemic clinical outcome measures (primary). We will secondarily assess the program's impact on glycemic process and economic measures.