Improving Glycemic Management for Better Outcomes, Cost Savings

Stephanie Ostling Mason, PharmD, CDCES, diabetes clinical pharmacist, Glytec, shares the challenges associated with insulin management in the hospital setting and offers advice to improve patient outcomes.

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network, where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Dr Stephanie Ostling Mason offers advice on how to improve insulin management in the clinical setting.

My name is Stephanie Ostling Mason. I am a pharmacist and certified diabetes care and education specialist, and I serve as the diabetes clinical pharmacist at Glytec. I've been in that role just over a year now.

Prior to joining the Glytec team, I practiced in the community or retail setting as well as ambulatory care. I was also the inpatient diabetes program manager for a health system in North Carolina.

What are some challenges associated with glycemic management?

I think there are probably more than what we have time for today, but I'll try to call out some of the big ones that I've seen in my experience and while working with clients.

The first one I would say is a lack of data. I know that many hospital systems struggle with data, even something as basic as tracking rates of hypoglycemia and hyperglycemia. Certainly, if you don't have data to tell you where you are today, it's very hard to improve.

Another challenge that hospitals face is a lack of standardization around workflows as far as how to order insulin and determine initial doses of sub-q insulin. That could be workflow-related, order set usage, those types of things. Lack of standardization is certainly a challenge.

I would also say lack of prioritization. Since the CMS inpatient glycemic measures have been live for over a year now, hospitals are becoming more aware of those, so hopefully glycemic management in the hospital will become much more of a priority.

The last one I want to comment on is the gap in basic diabetes and insulin knowledge. I saw that when I was a program manager and still see that working with clients today. It's really difficult to improve glycemic management in the hospital when you have to teach or reteach a lot of the basics around diabetes and insulin management.

Thank you. Stephanie. How do these obstacles impact patients, hospitals, pharmacists, or the health care industry more generally?

When we, as health care providers, aren't using insulin safely and effectively in the hospital, that ultimately trickles down to our patients and care. Great example: let's say we don't have a standardized process for how we order sub-q insulin, and we have a patient who is inappropriately overdosed, whether that's from the ordering side or even the administrative side. That patient could experience severe hypoglycemia that could have otherwise been prevented.

We know that severe hypoglycemia is associated with increased risk of mortality and poor clinical outcomes for the patient. So when you think of that at the hospital level, that likely means increased length of stay, because the patient requires treatment that they would have otherwise not required. That's more staff hours and dollars that the hospital is spending to care for that patient.

Not using insulin safely and effectively in the hospital and having these poor clinical outcomes are not confined to a single hospital or health system. As an industry, many hospitals are struggling to improve the safe and effective use of insulin. When you have CMS, for example, coming out and saying, "Well we've got these 2 new measures,” calling hospitals to pay attention to those measures and really improve care, that's an industry-wide effort.

You can see those challenges impact all the way from patient level to health system and industry level.

What advice would you offer people practicing or entire health systems that are hoping to improve their metrics and outcomes for patients in need of insulin?

When I think about the time that I took over that inpatient diabetes program manager role, I think the best place to start is looking at what you have today. What data do you have? What information do you have on hypoglycemia, insulin dosing practices, etc? It's really hard to know where you need to go if you don't know where you are today. As part of that, you're able to identify the gaps in data and you can see where is a good place to start.

Insulin is a high alert medication. Pharmacists are the medication experts, so they absolutely need to be involved in that dialogue. Once you have the information of what we're doing today, look for trends, low-hanging fruit, things that you can tackle. Engage the right stakeholders. Set up a plan: this is how we're going to track it, this is our timeline, this is what we're trying to achieve. And then move forward with it.

That's the best piece of advice I can offer our pharmacists and health care teams today on how to begin to improve our glycemic management practices.

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