Insulin, Quality Improvement, Medication Safety, Pharmacy, Glycemic Management, Practice Change

Improving Glycemic Management in the ICU with a Pharmacy-Led Initiative: Critical Insights from Texas Health Huguley Hospital

Health systems are constantly evolving ecosystems. New patients arrive, order sets change, technology progresses and processes are tweaked to increase safety and efficiency. The continuous advancement within a hospital is best summarized by the great philosopher Heraclitus who said, “change is the only constant in life.”  

And that’s exactly how Dr. Angela Hodges, PharmD, RPH, LSSYB, BC-ADM kicked off the recent Becker’s Hospital Review webinar we co-hosted that explored glycemic change management in the ICU.  

Dr. Hodges represents Texas Health Huguley Hospital, part of Advent Health, a 291-bed facility located on the edge of Fort Worth, Texas. The health system is a joint venture between Texas Health Resources and Advent Health and received a CMS 5-STAR designation in 2021. Texas Health Huguley Hospital is a leader in glycemic management and the only acute care setting in Tarrant County with a Joint Commission Advanced Inpatient Diabetes certification.  

Best-in-Class Glycemic Management Programs Driven by Pharmacists 

While all best-in-class glycemic management programs have similarities, there is no one-size-fits-all roadmap. Instead, hospitals need to execute, adapt and improve based on their own ongoing changes and needs.  

During our conversation, Dr. Hodges provided a deep dive into the history of Texas Health Huguley Hospital’s glycemic program and how it drives continuous improvement to enhance patient safety and provider workflows. During the webinar, Dr. Hodges explained how a pharmacy-led initiative helped her hospital manage practice change in the ICU with some impressive results.   

Here are four key takeaways from the webinar:  

  1. Identify Roadblocks Early: Despite emergency department and ICU nurses doing a great job with legacy tools and processes, Dr. Hodges and her staff realized that their existing technology was unreliable and falling behind. The technology created problems, such as requiring physicians to enter an order set for patients in DKA or HHS separate from the initial insulin infusion. Additionally, the process for mealtime insulin infusions wasn’t consistent or clear-cut.  
  2. Leverage Next-Gen Decision Support Tools: To help remediate these problems, Texas Health Huguley transitioned to Glucommander IV decision-support software in the ICU. Glucommander is the FDA-cleared algorithm at the heart of Glytec’s eGMS that provides personalized insulin dosing and decision support at the point of care. eGMS also delivers advanced capabilities that help nurses and other providers, including reporting and analytics, improved workflows, patient risk identification and more.   
  3. Collaboration is Key: While the nurses in the ICU traditionally led the glycemic management initiatives at Texas Health Huguley Hospital, Glucommander requires clinical evaluation and decision-making. As such, the pharmacy department took the lead on the implementation. The success of this initiative hinged on the right mix of technology, people and processes. Dr. Hodges prioritized communication and training to ensure nurses, providers and pharmacists were always in alignment, trusted each other and had an appreciation for each other’s role in the new system. 
  4. Measurement is Critical: The only way to evaluate the success of a practice change is to assess key process indicators and metrics. Teams need to collectively agree on the appropriate metrics and review them periodically, so the results help indicate areas that need to change.  

The success Texas Health Huguley Hospital has realized during their glycemic practice change speaks for itself. Data showed that providers were getting patients into range within six hours using Glucommander IV at a greater than 80% rate. Additionally, before the process change, nurses entered data 85% of the time to get insulin infusions started. After the changes? Pharmacists accounted for 74% of these initiations, doctors and advanced practitioners combined for 22% and nurses just 4%. 

The proper collaboration enabled Dr. Hodges and her teammates to bring efficiency to the glycemic management processes with evidence-based tactics that allowed physicians to focus on other important clinical factors. 

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