Interventions to Improve Adherence to a Hypoglycemia Protocol

Background.. A formal evidence-based hypoglycemia protocol and treatment algorithm were developed to provide safe and effective management of hypoglycemia throughout the hospital and to support organization goals to achieve blood glucose control. However, rechecking blood glucose 15 minutes after treatment for hypoglycemia, as outlined in the protocol, was challenging for the nursing staff. Education was delivered several times, and hypoglycemia badge reference cards were provided to reinforce the protocol. Nursing staff observed that hypoglycemia treatment took several minutes, so the recheck was set at 15–30 minutes from the time hypoglycemia was identified. Audits and staff reeducation were performed, but compliance remained low. Objective.. A pilot was conducted to compare two innovative interventions to improve adherence to the protocol. Methods.. To improve timely rechecks, two different interventions were tested. The first required patient care technicians (PCTs) to remain in the patient’s room for the full 15 minutes after treatment to perform the recheck. The second incorporated the use of timers to remind PCTs and nurses to perform the recheck. Results.. The timer group had significantly higher compliance with hypoglycemia rechecks than the group staying in the patient’s room (84 vs. 52%, P <0.0001). It is difficult for a PCT to remain in a patient’s room for a full 15 minutes. Timers enabled nurses and PCTs to perform other tasks without missing the recheck time. After implementation, the hospital achieved 75% compliance with the recheck. Conclusion.. This project demonstrated that the use of timers can be an effective and efficient way to remind busy hospital staff to recheck a patient’s blood glucose after hypoglycemia treatment.