Glycemic Monitoring and Control
The need to manage blood glucose levels is common among patients served in emergency, acute care, critical care and peri-operative settings. A number of tools have been developed to facilitate improved glycemic control for inpatients. These divide into those that facilitate surveillance and others that facilitate intervention. All are available when an inpatient chart is opened in the clinical information system (CIS).
Glycemic Monitoring
Clinician-facilitated Data
Three tools help appreciate inpatients’ blood glucose response to problems and interventions. The first two, an overview snapshot block and a glucose management summary, are part of the “Summary” section of an inpatient chart.
The third tool is a "Glucometer Overview" column that can be added to the Patient List. This column lets prescribers in the inpatient/on call setting review glucometer point of care testing (POCT) results directly from the Patient List, making it easier to identify patients who need diabetes medication review and titration, with colour-coded visual cues. The Glucometer Overview column has to be manually added to a prescriber’s Patient List; see the tip sheet for details.
Patient-facilitated Data
Another set of tools allows blood glucose monitoring data from patient observations and/or devices to be reviewed and incorporated into the Connect Care chart.
Patients can use the MyAHS Connect patient portal to enter their own capillary blood glucose measurements. They can transcribe data from a personal glucometer. In some cases, personal glucometers that integrate with SmartPhone apps can share data with Connect Care via standard interfaces (Apple Health for iPhones and iPads).
In order for this functionality to be available to patients, a few requirements must be met:
Patient
must have an active MyAHS Connect account, having followed instructions for activating the patient portal after securing an Alberta digital identity.Prescriber
must "order" an appropriate patient portal flowsheet for a patient who will enter or interface blood glucose information.
Glycemic Intervention - Basal Bolus Insulin Therapy (BBIT)
Connect Care supports the Basal Bolus Insulin Therapy (BBIT) protocol to help clinicians determine patients’ insulin requirements and the optimal types and timings of insulin administration.
A good place to get oriented to Connect Care insulin management is through the BBIT navigator, even though this is typically used as part of an insulin ordering sequence. Thereafter, the process for completing BBIT orders and taking advantage of embedded decision supports makes more sense.
Glycemic Intervention - Pre-procedure and Post-procedure
Most patients with hyperglycemia can be managed with the BBIT protocol for subcutaneous insulin administration peri-operatively, even when unable to eat (NPO). There are a number of additional considerations when navigating surgical intervention and anesthesia.
"Preprocedure Management of Patients with Diabetes" Order Sets are available for both adult and pediatric inpatients. These gather into one place all the booking, monitoring, testing, diet, fluid and insulin options that clinicians may choose from while aligning with evidence-informed peri-operative care.
Glycemic Intervention - NPO IV Insulin Management
A "NPO and Perioperative IV Insulin Management" Order Panel is embedded in the preprocedure diabetes Order Set and can be used independently (standalone panel) or in conjunction with the Oder Set. While the BBIT subcutaneous insulin protocol remains strongly recommended, even when patients are unable to eat (NPO), there may be situations in which NPO patients require intravenous insulin outside of the context of a pending procedure.