Nurse adherence to post-hypoglycemic event monitoring for hospitalized patients with diabetes mellitus.

Purpose: The aim of this study was to investigate adherence to a posthypoglycemic event-monitoring policy for inpatients with diabetes mellitus receiving insulin therapy.

Methods: We analyzed point-of-care blood glucose data from noncritically ill inpatients receiving insulin therapy who had a hypoglycemic event (<70 mg/dL glucose) from January 3, 2017, through April 7, 2018. Blood glucose was measured until 2 sequential readings showed hypoglycemia resolution. An interval of 10 to 20 min between measurements was defined as compliant with policy. We calculated the median (IQR) time of each interval.

Results: We analyzed 896 episodes of hypoglycemia in 426 patients: 698 events had only 1 hypoglycemic measurement; 165 had 2 sequential hypoglycemic measurements; and 33 had 3 sequential hypoglycemic measurements. Median (IQR) times between measurements ranged from 18 (15-23) minutes to 28 (21-38) minutes. For patients with 1 hypoglycemic measurement, less than 50% of follow-up measurements were compliant. Similarly, for those with 2 sequential hypoglycemic values, less than 50% of measurements were compliant; for those with 3 sequential hypoglycemic values, less than 58%.

Conclusion: Many instances of hypoglycemia had intervals between sequential glucose measurements that were longer than required by policy. These longer-than-expected intervals could place patients at undue risk for a prolonged hypoglycemic event. A better understanding of barriers to post-hypoglycemic event management in inpatients is required. Inpatient nurses, who are at the forefront of assessing and treating patients with hypoglycemia, should be key partners in assessing the algorithms for hypoglycemia care.