Improving Adherence to a Hyperglycemia Clinical Practice Guideline in an Inpatient Blood and Marrow Transplant Population
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Date
2019-05
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The Ohio State University
Abstract
Hyperglycemia is a known contributor to morbidity and mortality in hospitalized patients, especially those who have undergone blood or marrow stem cell transplantation. At this large Midwestern academic medical center, patients receiving BMT are at risk for developing hyperglycemia due to multiple factors, including comorbidities and treatment-specific risks. The primary purpose of this quality improvement project was to apply an evidence-based approach to increasing adherence to a hyperglycemia management guideline for patients admitted to the Blood and Marrow Transplant (BMT) service at the Comprehensive Cancer Center that is a component part of the academic medical center. Clinicians caring for BMT patients were surveyed regarding their attitudes, perceptions regarding hyperglycemia CPGs, as well as their adherence to use of these guidelines. Prior to analysis of survey findings, a multidisciplinary team reviewed the multiple current institutional hyperglycemia clinical practice guidelines (CPGs) and consolidated them in to a single, departmental-specific guideline. Following guideline consolidation, education was provided to BMT clinicians regarding the clinical implications of reducing hyperglycemia, and on the use of the newly consolidated evidence-based guideline. Clinicians were surveyed one month post implementation of the hyperglycemia CPG to assess for changes in perceptions towards use of the guideline, as well as adherence rates.
Comparison of pre and post-implementation survey results showed a significant increase in clinician knowledge regarding guideline concordant care, as well as reported use of the consolidated hyperglycemia CPG. The use of a department-specific CPG, combined with education regarding the clinical importance of hyperglycemia, may increase clinician adherence to evidence-based management of hyperglycemia.
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Keywords
hyperglycemia, blood and marrow transplant, clinical practice guidelines, quality improvement, multidisciplinary