Glycemic Management and Adverse Drug Events (ADEs)

An ADE is an injury resulting from a medical intervention related to a drug.¹ ADEs are among the most preventable causes of death in hospitals, and ADEs involving hypoglycemic agents comprise 57 percent of all ADEs, making this the largest drug class contributing to ADE-related harms.²

Risk factors for hypoglycemia during hospitalization include:

• Age.
• Comorbidities.
• Diabetes.
• History of hypoglycemia.
• Body mass index.
• Hyperglycemia therapies.
• Inadequate glucose monitoring.
• Unclear physician orders.
• Staffing shortages.
• Limited facilities/beds.
• Prolonged fasting.
• Nutritional intake combined with therapy.³

Hypoglycemia during hospitalization, or secondary hypoglycemia, is associated with increased mortality, cardiovascular disorders, cerebrovascular disorders, and increased cost of care and length of stay.³ Consider using the tools found in The Flash section to prevent and treat hypoglycemic ADEs in your facility.

Glycemic Management Rates

Data show improvement in glycemic management for ADEs (lower rates are better).

Visit the HSAG HQIC Quality Improvement and Innovation Portal (QIIP) to view your data by selecting the Measure category of Adverse Drug Events and the Measure of ADE Diabetic Agent.

Rates are per 1,000 admissions. For additional details on measure specifications, please reference the HSAG HQIC Compendium of Measures. The baseline time period is 01/01/2019–12/31/2019. The current time period is 08/01/2022–07/31/2023.

HSAG: Diabetes Zone Tool

This tool for newly discharged patients uses plain language to guide them in the importance of blood sugar management and dangerous symptoms.

HSAG: Glycemic Management Roadmap to Success

Use this planning and strategy tool to implement a multidisciplinary, coordinated, and systematic approach to inpatient glycemic management. Use input from frontline staff, nursing leadership, diabetes educators, and hospitalists—as well as the departments of endocrinology, pharmacy, dietary, quality management, risk management, clinical education, case management, and laboratory.

HSAG: Hypoglycemic Event Analysis Tool (HEAT)

HEAT is an investigative tool to document individual patient hypoglycemic events in the hospital.

U.S. Nursing Shortage

There is increased demand for healthcare, and the American Nurses Association (ANA) estimates that the U.S. needs more than one million new nurses in the next few years to prevent a critical nursing shortage. Reasons for the shortage include an aging workforce; retiring nurses; turnover; and lack of faculty, education space, and resources to train new nurses.⁴ The resources below address some of these issues: 

• Ten Things You Can Do to Support Nurses. AARP (Formerly American Association of Retired Persons). 
• R3—The Renewal, Resilience and Retention of Maryland Nurses Initiative. Johns Hopkins School of Nursing.
• Do I Still Belong? American Nurse Journal.
• Re-imagining Nursing’s Social Contract With the Public. American Nurse Journal.
• American Nurse. Journal of the ANA.

Care Coordination

Quickinar Series

Discover ways to manage avoidable hospital readmissions by registering for these short, 30-minute webinars (quickinars)—offered monthly January through May 2024. Find details and recordings for past presentations on the webpage.

1st Tuesdays. Next: January 9, 2024 (due to holiday) | 2–2:30 p.m. ET (11 a.m. PT)

Ensuring Medication for Opioid Use Disorder (MOUD) Treatment Through the Care Continuum

This webinar series—a collaboration of all Quality Improvement Organizations—provides strategies, interventions, and targeted solutions to ensure Medicare beneficiaries have access to MOUD treatment and facilitate the continuity of care through the continuum.

Next: January 12, 2024 | 12 noon ET (9 a.m. PT).

Find on-demand quickinar recordings, slides, and podcasts for past HSAG HQIC learning series.

Health Equity Quickinar Series

This series addresses the many facets and criteria for hospitals to meet the new Centers for Medicare & Medicaid Services (CMS) Hospital Commitment to Health Equity Structural Measure and Social Drivers Screening Measures.

Patient/Family Engagement (PFE) Quickinar Series

This series addresses the CMS 5 Metrics for PFE and provides facilities a framework to engage patients and families in their care.

Quality and Safety Quickinar Series

Find resources to assist your quality improvement journey, from planning and preparation to sustaining your organization's gains.

References

1 Kohn LT, Corrigan JM, Donaldson MS (Institute of Medicine). (2000). To err is human: building a safer health system. Washington DC: National Academy Press.  https://pubmed.ncbi.nlm.nih.gov/25077248/

2 ElSayed NA, et al. Glycemic Targets: Standards of Care in Diabetes – 2023. (2023). Diabetes Care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810469/

3 Pratiwi C, et al. The risk factors of inpatient hypoglycemia: A systematic review. (2020). Heliyon. https://www.cell.com/heliyon/pdf/S2405-8440(20)30758-1.pdf

4 Hamlin K. Why is there a nursing shortage? (2023). Nurse Journal. https://nursejournal.org/articles/why-is-there-a-nursing-shortage/#:~:text=An%20Aging%20Workforce,nurses%20will%20retire%2C%20leaving%20vacancies. 

This material was prepared by Health Services Advisory Group (HSAG), a Hospital Quality Improvement Contractor (HQIC) under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No XS-HQIC-XT-12062023-01