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Cited by 24Patient Safety and Medication ErrorsHyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and Research

Multifaceted approach to reducing occurrence of severe hypoglycemia in a large healthcare system

Milligan, Paul E., Bocox, Mary C., Pratt, Elizabeth, Hoehner, Christine M., Krettek, John E., Dunagan, Wm. Claiborne·2015·American Journal of Health-System Pharmacy
DOI 10.2146/ajhp150077
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Abstract

Purpose Substantial reductions in inpatient episodes of severe hypoglycemia achieved by a large healthcare system through enhanced use of technology and sustained quality-improvement initiatives are described. Summary After internal data collection and analysis revealed that severe hypoglycemia accounted for 75% of all systematically monitored adverse drug events in its hospital network, St. Louis-based BJC HealthCare designed and executed a multifaceted approach to reducing hypoglycemia events. Initiated by a pharmacist-led task force, the project entailed (1) automated event detection and creation of dashboards for comparing hypoglycemia rates among at-risk patients at 11 BJC facilities, (2) implementation of evidence-based and internal best practices in use at BJC's top-performing hospitals, (3) development of an online "Hypoglycemic Event Analysis Tool" (HEAT) to support event investigation and collection of data on causative factors, and (4) the assembly of targeted interventions at a "Hypoglycemia Facility Strategy Tracking" (H-FaST) intranet site. As a result of the launch of the HEAT and H-FaST tools and associated provider education activities, the systemwide rate of hypoglycemia events in the specified at-risk patient population declined from 6.45 per 1000 patient-days during a preimplementation baseline period (July-December 2009) to 1.32 per 1000 patient-days during a designated postimplementation period (January-June 2014), an 80% overall reduction in hypoglycemi…

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  • Studies of bundled preventive therapies, including proactive surveillance of glycemic outliers and an interprofessional data-driven approach to glycemic management, showed that hypoglycemic episodes in the hospital could be reduced or prevented.

    “Studies of “bundled” preventive therapies, including proactive surveillance of glycemic outliers and an interprofessional data-driven approach to glycemic management, showed that hypoglycemic episodes in the hospital could be reduced or prevented (107,108).”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [108]

  • Compared with baseline, studies found that hypoglycemic events decreased by 56-80%.

    “Compared with baseline, studies found that hypoglycemic events decreased by 56-80% (100,107,108).”

    From 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 (2026) · cites this paper as [108]

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Authors
Milligan, P. E., Bocox, M. C., Pratt, E., Hoehner, C. M., Krettek, J. E., & Dunagan, W. C.
Affiliations
  • BJC HealthCare (US)
  • Barnes-Jewish Hospital (US)
Corresponding author
Milligan, Paul E.
ORCID
Venue
American Journal of Health-System Pharmacy
Publisher
Oxford University Press (OUP)
Published
2015-10-01
Volume
72
Issue
19
Pages
1631-1641
ISSN
  • 1079-2082 (ISSN-L)
  • 1535-2900
DOI
10.2146/ajhp150077
OpenAlex
W2180295072
Cited by
24
References
19
Citations by year
2025: 3 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 5 · 2020: 1 · 2019: 3 · 2018: 1 · 2017: 4 · 2016: 1
FWCI
3.45
Type
journal article
Language
en
Open access
closed
Locations
  • American Journal of Health-System Pharmacy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
severe hypoglycemia, adverse drug reactions, quality improvement, automatic event detection, dashboards, provider education, hospital networks, diabetes management
MeSH terms
Adrenal Cortex Hormones, Blood Glucose, Humans, Hypoglycemia, Hypoglycemic Agents, Inpatients, Inservice Training, Pharmacy Service, Hospital, Risk Factors, Severity of Illness Index, Nutrition Assessment, Quality Improvement

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