A Pharmacist-Driven Glycemic Control Protocol to Reduce the Rate of Severe Hypoglycemia in High-Risk Patients.

Purpose: Hospital pharmacists contribute to patient safety and quality initiatives by overseeing the prescribing of antidiabetic medications. A pharmacist-driven glycemic control protocol was developed to reduce the rate of severe hypoglycemia events (SHE) in high-risk hospitalized patients. Methods: We retrospectively analyzed the rates of SHE (defined as blood glucose ≤40 mg/dL), before and after instituting a pharmacist-driven glycemic control protocol over a 4-year period. A hospital glucose management team that included a lead Certified Diabetes Educator Pharmacist (CDEP), 5 pharmacists trained in diabetes, a lead hospitalist, critical care and hospital providers established a process to first identify patients at risk for severe hypoglycemia and then implement our protocol. Criteria from the American Diabetes Association and the American Association of Clinical Endocrinologists was utilized to identify and treat patients at risk for SHE. We analyzed and compared the rate of SHE and physician acceptance rates before and after protocol initiation. Results: From January 2015 to March 2019, 18 297 patients met criteria for this study; 139 patients experienced a SHE and approximately 80% were considered high risk diabetes patients. Physician acceptance rates for the new protocol ranged from 77% to 81% from the year of initiation (2016) through 2018. The absolute risk reduction of SHE was 9 events per 1000 hospitalized diabetic patients and the relative risk reduction was 74% SHE from the start to the end of the protocol implementation. Linear regression analysis demonstrated that SHE decreased by 1.5 events per 1000 hospitalized diabetic patients (95% confidence interval, -1.54 to -1.48, P < .001) during the 2 years following the introduction of the protocol. This represents a 15% relative reduction of SHE per year. Conclusion: The pharmacist-driven glycemic control protocol was well accepted by our hospitalists and led to a significant reduction in SHE in high-risk diabetes patient groups at our hospital. It was cost effective and strengthened our physician-pharmacist relationship while improving diabetes care.

Transformation of Hospital Pharmacist Opioid Stewardship.

Purpose: The heightened involvement of government organizations to improve pain management and mitigate opioid adverse events brings to light the need for an opioid stewardship model. Summary: The US opioid epidemic has resulted in new hospital requirements for pain management by regulatory agencies. Opioid stewardship is a concept in the early development stage of pharmacy practice. There exists a need for a cohesive vision of opioid stewardship and the role of the pharmacist. Over the course of 17 years, the tracks for opioid stewardship in Fairview Health Services were laid through numerous initiatives to mitigate adverse events and improve the quality of pain management. This article will describe a transformation process for establishing the framework for opioid stewardship within Fairview Health Services and role of the pharmacist. Conclusions: The vision for opioid stewardship will ultimately be defined through the actions taken to improve quality care and patient safety. Opioid safety should be expanded to include stewardship of approaches that reduce the risk of diversion, overdose, and medication abuse. Pharmacists currently have a major role monitoring opioid medication in hospitals and this component will increase with new regulatory requirements.

Best-practice protocols: reducing harm from high-alert medications.

The Institute for Healthcare Improvement challenges clinicians and administrators to raise care quality through its 5 Million Lives Campaign, a sequel to the 100,000 Lives Campaign. Here, review a case study on the importance of postoperative monitoring of opioid-naive patients who are receiving narcotics.