Hospital Pharmacy - April 2018 - 123
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Hill et al
Table 1. Patient Demographics.
Demographics
No hypoglycemia (n = 16)
Hypoglycemiaa (n = 16)
P
43 (31.8, 60.5)
98.3 ± 31.4
6 (38)
8 (50)
14 (88)/4 (25)
35.8 ± 27.3
24 ± 7
5 (31)
8.2 ± 3.1
17.7 (10.3, 21.3)
3.6 ± 0.7
9.6 ± 4.6
15.8 (7.9, 21.1)
1.8 (0.8, 2.9)
51.7 (35.4, 188.4)
12 (75)
64 (40.3, 72.8)
91.6 ± 24.6
8 (50)
9 (56)
9 (56) / 3 (19)
28.2 ± 15.1
20 ± 8
14 (88)
7.6 ± 2.3
10.4 (6.5, 19.9)
3.1 ± 0.7
11 ± 4.7
8.2 (5.5, 15.5)
1.1 (0.7, 1.5)
92.4 (48.8, 152.9)
9 (56)
.04
NS
NS
NS
NS
NS
NS
.003
NS
NS
.055
NS
NS
.10
NS
NS
Age, yearsb
Weight, kgc
Male, n (%)
Caucasian, n (%)
Thermal/inhalation injury, n (%)
TBSA, %c
APACHE IIc
Diabetes, n (%)
A1c, %c
WBC, cells/mm3b
Albumin, g/dLc
Prealbumin, mg/dLc
CRP, mg/dLb
SCr, mg/dLb
CrCL, mL/minb
AKI, n (%)
Note. NS = nonsignificant; TBSA = total body surface area burn; APACHE = acute physiology and chronic health evaluation; WBC = white blood cell;
CRP = C-reactive protein; SCr = serum creatinine; CrCl = creatinine clearance; AKI = acute kidney injury.
a
Blood glucose < 60 mg/dL.
b
Median (interquartile range).
c
Mean ± SD.
Table 2. Outcomes.
Outcomes
No hypoglycemia (n = 16)
Survived, n (%)
Infection, n (%)
Length of stay, daysb
Hours to achieve 70-149 mg/dLb
CII duration, daysb
Serum glucose, mg/dLc
Insulin usage, units/hb
Carbohydrate intake, g/db
8 (50)
13 (81)
21 (15.5, 40.3)
6.5 (1.5, 12.8)
4.2 (2.8, 11.5)
151.7 ± 13.3
4.1 (3.1, 8.9)
181.4 (168, 297.6)
Hypoglycemiaa (n = 16)
13 (81)
15 (94)
42.5 (23.8, 60)
5.8 (4.3, 8.5)
8.9 (3.8, 17.3)
151.1 ± 13.2
5.0 (3.4, 6.2)
178.6 (149.5, 204)
P
NS
NS
.08
NS
.08
NS
NS
.09
Note. NS = nonsignificant; CII = continuous insulin infusion.
a
Blood glucose < 60 mg/dL.
b
Median (interquartile range).
c
Mean ± SD.
this study is less aggressive and generally reserved for renal
failure. The modified protocol decreased the incidence of
hypoglycemia in renal failure patients from 91% to 62%.
Although the incidence did decrease, the rate of hypoglycemia in this study's renal failure patients is still unacceptable.
At the time of this study, 4 different CII protocols were
approved at the authors' institution. During the study period,
all 4 were utilized in the patient sample. The protocols varied
with respect to goal range, how to titrate and wean, and even
hypoglycemia definitions and treatment. The amount of
available protocols can be attributed to different prescribing
practices among physicians and complications implementing
a new electronic medical record. The excessive number of
protocols could have possibly attributed to the amount of
glucose variability and protocol violations. It is likely that
staff education could provide improvement in glycemic control and reduce protocol violations for the future. Even if
reduced, violations will likely still occur and only accounted
for about half of our explained events. Perhaps limiting the
amount of protocols prescribed and standardizing a hypoglycemic protocol will prevent confusion on goals and enhance
glycemic control.
Table of Contents for the Digital Edition of Hospital Pharmacy - April 2018
Ed Board
TOC
HPX
Why Is Burnout a Taboo?
Stability of 2 mg/mL Adenosine Solution in Polyvinyl Chloride and Polyolefin Infusion Bags
Glecaprevir/Pibrentasvir
New Medications in the Treatement of Acute Decompensated Heart Failure
The Prescription Drug User Fee Act: Cause for Concern?
ISMP Medication Error Report Analysis
ISMP Adverse Drug Reactions
Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital
Breadth of Statistical Training Among Pharmacy Residency Programs Across the United States
Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study
Changes in Pharmacy Residency Training Design Between 2012 and 2017: A Perspective of Academic Medical Centers
Incidence of Hypoglycemia in Burn Patients: A Focus for Process Improvement
Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy
Hospital Pharmacy - April 2018 - Cover1
Hospital Pharmacy - April 2018 - Cover2
Hospital Pharmacy - April 2018 - Ed Board
Hospital Pharmacy - April 2018 - TOC
Hospital Pharmacy - April 2018 - HPX
Hospital Pharmacy - April 2018 - Why Is Burnout a Taboo?
Hospital Pharmacy - April 2018 - Stability of 2 mg/mL Adenosine Solution in Polyvinyl Chloride and Polyolefin Infusion Bags
Hospital Pharmacy - April 2018 - 74
Hospital Pharmacy - April 2018 - Glecaprevir/Pibrentasvir
Hospital Pharmacy - April 2018 - 76
Hospital Pharmacy - April 2018 - 77
Hospital Pharmacy - April 2018 - 78
Hospital Pharmacy - April 2018 - 79
Hospital Pharmacy - April 2018 - 80
Hospital Pharmacy - April 2018 - 81
Hospital Pharmacy - April 2018 - 82
Hospital Pharmacy - April 2018 - 83
Hospital Pharmacy - April 2018 - 84
Hospital Pharmacy - April 2018 - New Medications in the Treatement of Acute Decompensated Heart Failure
Hospital Pharmacy - April 2018 - 86
Hospital Pharmacy - April 2018 - 87
Hospital Pharmacy - April 2018 - The Prescription Drug User Fee Act: Cause for Concern?
Hospital Pharmacy - April 2018 - 89
Hospital Pharmacy - April 2018 - ISMP Medication Error Report Analysis
Hospital Pharmacy - April 2018 - 91
Hospital Pharmacy - April 2018 - 92
Hospital Pharmacy - April 2018 - ISMP Adverse Drug Reactions
Hospital Pharmacy - April 2018 - 94
Hospital Pharmacy - April 2018 - 95
Hospital Pharmacy - April 2018 - Development and Implementation of a Combined Master of Science and PGY1/PGY2 Health-System Pharmacy Administration Residency Program at a Large Community Teaching Hospital
Hospital Pharmacy - April 2018 - 97
Hospital Pharmacy - April 2018 - 98
Hospital Pharmacy - April 2018 - 99
Hospital Pharmacy - April 2018 - 100
Hospital Pharmacy - April 2018 - Breadth of Statistical Training Among Pharmacy Residency Programs Across the United States
Hospital Pharmacy - April 2018 - 102
Hospital Pharmacy - April 2018 - 103
Hospital Pharmacy - April 2018 - 104
Hospital Pharmacy - April 2018 - 105
Hospital Pharmacy - April 2018 - 106
Hospital Pharmacy - April 2018 - Antihypertensive Prescription Pattern and Compliance to JNC 7 and JNC 8 at Tertiary Care Government Hospital, Hyderabad, India: A Cross-sectional Retrospective Study
Hospital Pharmacy - April 2018 - 108
Hospital Pharmacy - April 2018 - 109
Hospital Pharmacy - April 2018 - 110
Hospital Pharmacy - April 2018 - 111
Hospital Pharmacy - April 2018 - 112
Hospital Pharmacy - April 2018 - Changes in Pharmacy Residency Training Design Between 2012 and 2017: A Perspective of Academic Medical Centers
Hospital Pharmacy - April 2018 - 114
Hospital Pharmacy - April 2018 - 115
Hospital Pharmacy - April 2018 - 116
Hospital Pharmacy - April 2018 - 117
Hospital Pharmacy - April 2018 - 118
Hospital Pharmacy - April 2018 - 119
Hospital Pharmacy - April 2018 - 120
Hospital Pharmacy - April 2018 - Incidence of Hypoglycemia in Burn Patients: A Focus for Process Improvement
Hospital Pharmacy - April 2018 - 122
Hospital Pharmacy - April 2018 - 123
Hospital Pharmacy - April 2018 - 124
Hospital Pharmacy - April 2018 - Physical Compatibility of Micafungin With Sodium Bicarbonate Hydration Fluids Commonly Used With High-Dose Methotrexate Chemotherapy
Hospital Pharmacy - April 2018 - 126
Hospital Pharmacy - April 2018 - 127
Hospital Pharmacy - April 2018 - 128
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