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NHA Recognizes Community Hospital for Improving Patient Care

September 27, 2018

Community Hospital’s diabetic team recently received recognition from the Nebraska Hospital Association for their work on reducing patient harm by developing processes to decrease the number of inpatients experiencing hypoglycemia who had received insulin. The team includes (back) Paulette Burkhardt, R.N., Patient Education; Chase Crawford, Pharmacist; Misti Soderlund, R.N., Director of Inpatient Services; (front) Anthony Rodewald, Director of Pharmacy and Monica Wacker, R.N., Diabetic Educator. Not pictured is Linda Nielsen, R.N. and Helen McSwain, R.N., Director of Support Services.

LINCOLN, NEB. – Community Hospital was recently recognized by the Nebraska Hospital Association for their work to improve quality of care as part of national Partnership for Patients’ Hospital Improvement Innovation (HIIN) Network initiative. The HIIN’s goal is to achieve a 20 percent decrease in overall patient harm and a 12 percent reduction in 30-day hospital readmissions as a population-based measure (readmissions per 1,000 people) from the 2014/2015 baseline. Efforts focus on consistently providing high quality care to the individuals in each community in Nebraska.

During the first year of the HIIN, October 2016-October 2017, Nebraska’s 69 hospitals demonstrated improvement in reducing patient harm including an estimated:

  • 3,672 patient harms prevented
  • 310 lives saved
  • $27.3 million in cost avoidance

Community Hospital was able to reduce patient harm by developing processes to decrease the number of inpatients experiencing hypoglycemia (defined as blood sugar of 50 or below) who had received insulin.

Anthony Rodewald, registered pharmacist and Director of Pharmacy at Community Hospital, says that in 2015, 10% of Community Hospital patients receiving insulin experienced hypoglycemia, or low blood sugars. “We consider this a preventable event that can cause harm to the patient,” he said. With this baseline, they set a goal to reduce these events to 5% and began to develop and implement strategies. Now, in 2018, the rates have been reduced to 4.14%.

This success was achieved by developing these steps:

  • First, awareness of the adverse drug events was raised with the hospital’s medical staff and nurses.
  • Second, the hospital pharmacy provided education to medical staff on the ADA’s standards of care for safe glucose levels in hospital patients. By building a special “rule” in the electronic medical record system, the pharmacy is alerted if a patient has a blood sugar following a lab draw of below 100. The pharmacy then contacts the physician to change the insulin dosage based on that alert.
  • Third, Patient alerts were added to the electronic medical record system to notify a provider/physician if a patient had previous history of hypoglycemia in the hospital.
  • Fourth, the pharmacy received approval from the medical staff to check blood sugars of diabetics at 2 a.m. “This step might have had the greatest effect,” Rodewald said, “because most blood sugars drop in the early morning hours.” If the blood sugar was low, patients were given a snack.

For more than a year now, Community Hospital has been using these four steps to treat diabetic inpatients. A fifth step was also added. Approval was acquired from med staff to automatically implement the hypoglycemic protocol for any patient who had insulin ordered. This included a standing order that dextrose can be given to the patient. The standing order allows the patient with low blood sugar to be treated in a timely fashion

The Nebraska Hospital Association (NHA) and 69 Nebraska hospitals partner with The Health Research and Educational Trust of the American Hospital Association (HRET) in this important work. The AHA is one of 16 national, regional, or state hospital associations, Quality Improvement Organizations (QIO), and health system organizations selected by Centers for Medicare & Medicaid Services (CMS) to work on the Partnership for Patients initiative, reducing preventable hospital-acquired conditions and readmissions.

The Partnership for Patients model was one of the first models established in 2011 to be tested under the authority of section 1115A of the Social Security Act with the goal of reducing program expenditures while preserving or enhancing the quality of care. Since the launch of Partnership for Patients and the work of Hospital Improvement Innovation Networks in collaboration with many other stakeholders, the vast majority of U.S. hospitals have delivered results as demonstrated by the achievement of unprecedented national reductions in harm.

For more information on the Partnership for Patients and the Hospital Improvement Innovation Networks, please visit partnershipforpatients.cms.gov.

The Nebraska Hospital Association is the unified voice for Nebraska’s hospitals and health systems. The association offers collaborative leadership, assisting its members to provide comprehensive care to their communities, improving the health status of those communities. For more information, visit the NHA website at www.NebraskaHospitals.org.

For information, contact Brian Noonan, senior director of communications and education at 402-742-8151 or bnoonan@nebraskahospitals.org.

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