Taking flight: Adopting technology to improve inpatient glycemic management

Healthcare is often compared to the airlines industry. From customer satisfaction to logistical planning, we are able to draw similarities.

While healthcare has taken cues on how to engage patients and improve patient experience, one area where the industry is still lagging behind aviation is safety.

In the airlines industry, the safety of flying has been dramatically improved over the past 50 years. With each new iteration of aircrafts, there has been a staggering reduction in the number of fatal accidents. For instance, in the 1960s, piston-engine planes dominated commercial airline fleets and had an accident rate of 27.2 accidents per million departures. Today’s aircrafts are far more advanced. In addition to design and engine innovations, new technology in the cockpit and from ground control have decreased the rate of accidents to one accident for every 16 million flights.

In comparison, hospital medical errors remain one of the leading causes of death in the United States. There are an estimated 200,000 preventable medical deaths every year, which is equivalent to three fatal airline crashes per day.

If there were really three airline accidents per day, not many people would be flying still. Healthcare needs to improve safety and we again can learn from the airlines industry.

The safety of flying improved with the introduction of new technology and protocols. While healthcare has certainly benefited from the introduction of technology and new methods, adoption of such advancements doesn’t happen nearly as quickly as it should.

How we dose insulin in the inpatient setting is a prime example. Insulin is the most frequently prescribed drug in most hospitals, and yet it remains ones of the most dangerous drugs administered. One-third of all fatal medication errors are caused by insulin, and this is because more than 95% of hospitals still use a manual process to calculate insulin doses. For years, hospitals have been using paper protocols, such as the Yale and Portland protocols, with complex calculations to dose insulin. They often are prone to miscalculations, are very time consuming for the nursing staff, and are difficult to ensure compliance with dosing recommendations.

Even if these protocols are automated within the EMR or with home-grown calculators, it’s not enough. Automating these protocols only eliminates one error: the manual calculation. It still lacks the advanced calculations that are necessary for precise, personalized glycemic management to reduce infections and avoid hypoglycemia. It’s akin to flying an airplane with an older engine. It’s not the safest mode.

To provide patients with the safest care, hospitals need to take advantage of a more advanced approach to insulin dosing utilizing an electronic glucose management system (eGMS). With an eGMS, it not only automates dosing recommendations to remove error-prone calculations and time-intensive steps for nursing staff, the software provides dosing recommendations that account for a patient’s individual response to insulin. Not all patients have the same response to or tolerance of insulin and these patient-specific factors need to be addressed in the insulin dose recommendation.

Not all eGMSs are created equal either. The safer solutions account for blood glucose level, weight, type of diabetes mellitus (DM), age, sex, as well as kidney function, residual insulin, and steroids that a patient may be on. With a more personalized approach to insulin dosing, patients can reach their target glucose levels faster and maintain optimal blood glucose with less variability. Most importantly, they can help keep the patient safe by reducing infection and preventing hypoglycemia.

When getting on an airplane, you want to know that you are safe. This means all contingencies have been thought of and the pilots are using the safest technology available. Why should healthcare be any different? As the number of hospital admissions for patients with diabetes and hyperglycemia continues to grow rapidly, hospitals need to make a change. Patients want the safest care possible, and in the case of insulin dosing, that means we must adopt advanced technology for more personalized and safe insulin dosing recommendations.

About the Author:
Laurel Fuqua, RN, MSN is the Executive Vice President and Chief Clinical Officer at Monarch Medical Technologies. As an accomplished executive and diabetes industry leader, Laurel draws from more than three decades of healthcare experience to lead the clinical vision and guide the product strategy at Monarch. She has held executive-level positions across a wide range of healthcare settings including, hospitals, health plans, care management, and diabetes technology firms. Laurel is a member of the 2018 AADE Board of Directors. She regularly speaks on the safety of glucose management and has received several accolades for her work, including the AADE Diabetes Educator of the Year Award early in her career. Laurel received her Bachelor of Science and Master of Science in Nursing from the University of Evansville.

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