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BACKGROUND Severe hypoglycemia (SH), defined as a blood glucose (BG)

PURPOSE: The aim of this study was to assess the incidence of hypoglycemia in hospitalized patients following acute treatment of hyperkalemia with insulin. A characterization of the affected patients and the administered insulin/dextrose regimens was also performed. METHODS: A retrospective search of the electronic records of a large university-based tertiary care hospital was conducted, from June 1, 2009 to December 1, 2009, to identify patients who developed hypoglycemia following acute stabilization of hyperkalemia treatment with regular insulin. RESULTS: Of 219 hyperkalemic patients who met the criteria of the study, 19 patients (8.7%) were identified as hypoglycemic (blood glucose

BACKGROUND: In-hospital insulin administration is associated with many medication errors, but the frequency and reasons for insulin administration errors are poorly described. To document types and frequency of errors related to insulin administration, an examination of 4 units was conducted. METHODS: Using snapshot methodology, 4 non-intensive care unit (ICU) areas (medicine, cardiology, transplant, and surgery) were examined in an observational, prospective manner for 4 weeks. Each patient on insulin on the first day was followed for 7 days. Definitions and error categories were defined prior to data collection. Error types and numbers were collected and quantified on per-day or per-patient basis. RESULTS: A total of 116 patient audit periods covering a total of 378 inpatient hospital days were examined. Inpatient insulin regimens on day 1 included correctional insulin only (51.7% of cases), neutral protamine Hagedorn ([NPH] 12%), and glargine (28.4%). A total of 199 administration errors occurred at a rate of 1.72 errors/patient-period and 0.53 errors/patient day. Missing documentation of doses (15.5% of all patients) and insulin being held without an order (25% of patients) were the most frequently occurring events. Other errors include transcription (7.5%), timing errors (22.7%), and lack of documentation of physician notification of hypoglycemia (12.6%). CONCLUSIONS: Errors associated with insulin in the hospital are common and reveal a number of system errors that should be addressed. These data provide a foundation for future performance improvement. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine

Hyperkalemia treatment with intravenous insulin has been associated with hypoglycemia. This single-center, retrospective study compared the effects on hypoglycemia between weight-based insulin dosing (0.1 U/kg of body weight up to a maximum of 10 U) compared to standard flat doses of 10 U among patients weighing less than 95 kg. Of the 132 charts randomly selected for review, hypoglycemic events (blood glucose

Severe hypoglycemia (SH), defined as a blood glucose (BG)40 mg/dL, is associated with an increased risk of adverse clinical outcomes in inpatients.To determine whether a predictive informatics hypoglycemia risk-alert supported by trained nurse responders would reduce the incidence of SH in our hospital.A 5-month prospective cohort intervention study.Acute care medical floors in a tertiary care academic hospital in St. Louis, Missouri.From 655 inpatients on designated medical floors with a BG of90 mg/dL, 390 were identified as high risk for hypoglycemia by the alert system.The primary outcome was the incidence of SH occurring in high-risk intervention versus high-risk control patients. Secondary outcomes included: number of episodes of SH in all study patients, incidence of BG 60 mg/dL and severe hyperglycemia with a BG299 mg/dL, length of stay, transfer to a higher level of care, the frequency that high-risk patient's orders were changed in response to the alert-intervention process, and mortality.The alert process, when augmented by nurse-physician collaboration, resulted in a significant decrease by 68% in the rate of SH in alerted high-risk patients versus nonalerted high-risk patients (3.1% vs 9.7%, P = 0.012). Rates of hyperglycemia were similar on intervention and control floors at 28% each. There was no difference in mortality, length of stay, or patients requiring transfer to a higher level of care.A real-time predictive informatics-generated alert, when supported by trained nurse responders, significantly reduced inpatient SH.