January 15, 2014
Pharmacists Now Doing More for People With Diabetes
I must admit my feeling about the help that pharmacists are providing to people with diabetes is very positive. Pharmacists are stepping up their public relations (PR), putting their activities into action, and doing a lot more for all people with diabetes than certified diabetes educators (CDEs) have done in a long time.
This action started five years ago in a hunt for the cause of hypoglycemia in the 11 hospitals in the BJC HealthCare system according to Paul Milligan, PharmD, medication safety officer at BJC HealthCare in St. Louis, Missouri. First they realized that adverse drug events were responsible of 20 percent of the preventable harm that occurred in their system. Next they lead a multidisciplinary mission to reduce them.
What they discovered was that 77 percent of the adverse events were caused by severe hypoglycemia. Dr. Milligan described this as a hidden epidemic that was not on anybody's radar. This was discovered by working with each hospitals informatics department to track the origin of drug events. That revelation presented particular challenges. Hypoglycemia has assorted and complex root causes - from prescribing, to drug administration, to patient compliance, to food issues, to equipment variances. Dr. Milligan explained that the population available to study was very large — about a third of the patients in the system had diabetes.
This was not what they had expected, but because clinicians mainly focus on the primary reason the patient is admitted to the hospital, and diabetes is often secondary. Making the problem even more complex was when pharmacists teamed up with physicians, nurses, dietitians, and diabetes educators to study the problem at 11 hospitals in the BJC system. This team discovered that each hospital had a different primary root cause for the hypoglycemia. At one hospital, the 3 people delivering the food, testing the blood, and delivering the insulin came in at different times, so could not perform their actions simultaneously, which is preferable. At another hospital, admitted patients were getting fewer calories than they did at home, but were receiving the same medication dose, which caused blood sugar to drop.
Once the root causes were determined, the team developed procedures customized to each hospital. That was one key to BJC's success, because they didn't try to implement one standard list across all the hospitals. We dealt with the biggest problem at each hospital, and sometimes only on the problem floors. You get a big impact and bigger buy-in if staff can see direct results.
“Elizabeth Pratt, DNP, RN, from Barnes-Jewish Hospital, which is part of BJC HealthCare, said some of the problem was a lack of awareness among clinicians about hypoglycemic trends in patients and a lack of automated triggers that would alert clinicians to monitor glucose levels.”
"With heightened awareness and an alert system, we're able to recognize those people earlier, have a multidisciplinary discussion with the nurses, pharmacists, and physicians," and ask whether the regimen should be adjusted, she said.
Now that the initial problems are under control, Dr. Pratt has taken over maintenance of the program, system-wide. In 2014, the program will be expanded to include the prevention and treatment of hyperglycemia, she reported.
Now, instead of an average 138 such events per month, the system averages in the 30s, said Paul Milligan, PharmD, medication safety officer at BJC HealthCare in St. Louis, Missouri. The team has been credited with preventing more than 2100 hypoglycemic events, which saved 8127 inpatient days and more than $7 million in hospital costs.