scholarly journals Impact of a Multi-disciplinary C. difficile Action Team

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S396-S397
Author(s):  
Emily Heil ◽  
Bharathi Sivasailam ◽  
SoEun Park ◽  
Jose Diaz ◽  
Erik Von Rosenvinge ◽  
...  
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Disciplinary Action ◽  
Treatment Modalities ◽  
Interventional Treatment ◽  
Post Intervention ◽  
Fecal Microbiota Transplant ◽  
Action Team

Abstract Background Clostridium difficile infection (CDI) is associated with increased length of hospital stay, morbidity, mortality, and cost of hospitalization. Early intervention by experts from multiple areas of practice such as gastroenterology (GI), infectious diseases (ID) and surgery can be essential to optimize care and increase utilization of novel treatment modalities such as fecal microbiota transplant (FMT) and minimally invasive, colon-preserving surgical management. Methods A multi-disciplinary C. difficile action team (MD-CAT) was implemented at University of Maryland Medical Center (UMMC) in March 2016 to engage appropriate specialty consultants in the care of CDI patients. The MD-CAT reviews positive C. difficile tests at UMMC and provides guidance and suggestions to the primary team including optimal antibiotic treatment (for CDI and any concomitant infection), and consultant involvement including ID, surgery, and GI, when appropriate. Using retrospective chart review, CDI patient management and outcomes were compared before and after implementation of the MD-CAT. Differences in the time to consults and frequency of interventional treatment was compared using Chi-square or Wilcoxon Rank-sum test. Results We compared 48 patients with CDI in the pre-intervention with 89 patients in the post-intervention period. Demographic and clinical characteristics of the groups were similar. MD-CAT intervention was associated with frequent (73%) modification or discontinuation of concomitant antibiotics. Median time to GI and ID consults was significantly shorter in the post group (P = 0.007 and P = 0.004, respectively). Five of 89 (5.6%) of patients received FMT or colon-preserving surgical intervention in the post-intervention group compared with no patients in the pre-intervention group. There was no difference in 30-day all-cause mortality or CDI recurrence between groups. Conclusion Early, multi-disciplinary action on patients with CDI increased the proportion of patients undergoing active specialty consultation and improved use of concomitant antibiotics. A larger sample size is needed to determine the effects of such a team on other clinical outcomes. Disclosures All authors: No reported disclosures.

Decreasing time to initiation of inpatient chemotherapy at LAC+USC medical center utilizing an admission checklist.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 262-262
Author(s):  
Ronak Patel ◽  
Victor Chiu ◽  
Darcy V. Spicer
Keyword(s):  
Medical Center ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Safety Net ◽  
Outpatient Setting ◽  
Post Intervention ◽  
Safety Net Hospital ◽  
The Mean ◽  
Chemotherapy Initiation ◽  
Mean Time

262 Background: Delays in the initiation of chemotherapy for scheduled inpatient admissions cause excess lengths of stay and shift infusion start times to the evenings when hospital staffing is decreased. We sought to characterize delays in our admission process and assess the feasibility of using an admission checklist to shorten start times in a large academic safety-net hospital. Baseline data for scheduled chemotherapy admissions in July and August of 2017 (n = 25) showed a mean time to chemotherapy initiation of 14.6 hours and mean excess LOS was 0.7 midnights. Significant delays were identified in the time between ordering and resulting of pre-chemotherapy labs (average 2.6 hours), and the time required to obtain imaging to confirm peripheral-inserted central catheter (PICC) position (1.6 hours). Methods: We created a checklist of a standardized admission workflow for physicians, which included moving all pre-chemotherapy labs, pharmacy verification of chemotherapy regimen, and PICC imaging to the outpatient setting. We organized multiple staff in-services to introduce the admission workflow prior to implementation on May 1, 2018. We then performed a retrospective chart review of all scheduled inpatient chemotherapy admissions from May to August of 2018. Results: In the first 2 months after intervention, the mean time to chemotherapy initiation was 8.5 hrs, representing a 42% reduction. In the subsequent 2 months, the mean time to chemotherapy initiation was 11.6 hours, representing a 21% reduction from baseline. Mean excess LOS was 0.4 midnights and 0.5 midnights for those time periods, respectively. For the entire post-intervention group, 7 out of 26 patients obtained pre-chemotherapy labs in the outpatient setting. Conclusions: We observed an initial mean reduction of 6.1 hours in the time to start chemotherapy, as well as a reduction in mean excess length of stay with the introduction of a new admission workflow and admission checklist. We observed incomplete adoption of the checklist, and an increase in time to chemotherapy initiation after the first two months of implementation, suggesting that physician non-adherence represents a significant barrier to maintaining these reductions.

scholarly journals Impact of Changes in Urine Culture Ordering Practice on Antimicrobial Utilization in Intensive Care Units at an Academic Medical Center

2016 ◽  
Vol 37 (4) ◽  
pp. 448-454 ◽  
Author(s):  
Mohamed Sarg ◽  
Greer E. Waldrop ◽  
Mona A. Beier ◽  
Emily L. Heil ◽  
Kerri A. Thom ◽  
...  
Keyword(s):  
Intensive Care ◽  
Urine Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antimicrobial Use ◽  
Post Intervention ◽  
Icu Patients ◽  
Antimicrobial Utilization ◽  
Academic Medical

OBJECTIVETo assess antimicrobial utilization before and after a change in urine culture ordering practice in adult intensive care units (ICUs) whereby urine cultures were only performed when pyuria was detected.DESIGNQuasi-experimental studySETTINGA 700-bed academic medical centerPATIENTSPatients admitted to any adult ICUMETHODSAggregate data for all adult ICUs were obtained for population-level antimicrobial use (days of therapy [DOT]), urine cultures performed, and bacteriuria, all measured per 1,000 patient days before the intervention (January–December 2012) and after the intervention (January–December 2013). These data were compared using interrupted time series negative binomial regression. Randomly selected patient charts from the population of adult ICU patients with orders for urine culture in the presence of indwelling or recently removed urinary catheters were reviewed for demographic, clinical, and antimicrobial use characteristics, and pre- and post-intervention data were compared.RESULTSStatistically significant reductions were observed in aggregate monthly rates of urine cultures performed and bacteriuria detected but not in DOT. At the patient level, compared with the pre-intervention group (n=250), in the post-intervention group (n=250), fewer patients started a new antimicrobial therapy based on urine culture results (23% vs 41%, P=.002), but no difference in the mean total DOT was observed.CONCLUSIONA change in urine-culture ordering practice was associated with a decrease in the percentage of patients starting a new antimicrobial therapy based on the index urine-culture order but not in total duration of antimicrobial use in adult ICUs. Other drivers of antimicrobial use in ICU patients need to be evaluated by antimicrobial stewardship teams.Infect. Control Hosp. Epidemiol. 2016;37(4):448–454

scholarly journals Refining Blood Products Utilization: Every One (unit) Matters. Post-Intervention Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 27-28
Author(s):  
Caroline Hana ◽  
Khaled Deeb ◽  
Kayla DeSuza ◽  
Sweet Gerlie Smith ◽  
Stanislav Ivanov ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Intervention Group ◽  
Transfusion Practice ◽  
Lower Number ◽  
Post Intervention ◽  
Number Of Patients ◽  
Significant Difference ◽  
Transfusion Guidelines

INTRODUCTION: Transfusion of red blood cells (RBCs) is a balance between providing benefits for patients while avoiding risks of transfusion. Meta-analyses of randomized controlled trials (RCT) comparing restricted versus liberal blood transfusion showed that there was no significant difference in terms of morbidity, mortality, or risk of myocardial infarction. In fact, the restrictive strategy had a significantly lower risk of all-cause mortality in patients with gastrointestinal bleeding. It also resulted in a significantly lower number of transfused units and a lower number of patients needing a transfusion. Examining the extent of adherence to the American Association of Blood Banks (AABB) transfusion guidelines in our VA medical center showed that the average transfused units were 1.4 units per person. The Average pre-transfusion hemoglobin (Hgb) was 7.6. 54% received 2 units, whereas 46% received 1 unit. AIM OF THE WORK: To improve the blood transfusion practice in our VA medical center to better comply with the (AABB) transfusion guidelines and to establish a culture of change to improve patient safety, minimize risks of transfusion reaction and reduce the cost. METHODOLOGY: This is a prospective analysis of transfused patients in the period of November 2019 to April 2020 (n=228) as a continuation of the prior retrospective analysis of randomly selected patients in 2018 (n=162). The data was retrieved from an electronic medical record database, which included patient gender, age, co-morbidities, mean baseline Hgb, pre- and post-transfusion Hgb, hemodynamic status, ordering division, and the number of units transfused. INTERVENTIONS We implemented a two-tier auditing system, based on a low and high priority, which reflects the timeline to address non-compliant transfusion orders. Low priority orders were evaluated during the periodic meeting of the transfusion committee, and high priority orders were addressed within a few hours of the transfusion order. All transfusion orders of Hgb > 7-8 g/dL were flagged with low priority, whereas those with Hgb > 8 g/dL and/or with orders exceeding one unit were flagged with high priority. The appropriate approval was obtained through the institutional review board (IRB), patients' consents for enrollment, and anonymity was maintained all through the study. RESULTS: The total number of transfused PRBC units was 386 units with a mean of 1.6 units per patient compared to 1.7 units in the pre-intervention group (p=0.056). The average Hgb before transfusion was 7.7 mg/dL compared to 7.5 mg/dL in the pre- versus the post-intervention group (p=0.659). Comparing the pre-transfusion Hgb values in both groups per ordering division showed that the average Hgb values were lower after the intervention among all divisions except for the hematology/oncology department. This difference was statistically significant in the Intensive Care Unit (ICU). In terms of the number of transfused units, overall, there was a decrease in the number of transfused units, however, this was not statistically significant.(table 1) The department with the highest number of transfused units was internal medicine. DISCUSSION: Our study showed that the application of an auditing system within the electronic medical system resulted in significant improvement in the transfusion practice in the ICU department. The lack of significant effects among other departments can be attributed to the lower number of cases in the pre- versus post-intervention cohorts, e.g. 22 versus 50 in the Hematology/Oncology department and 6 versus 26 in the Emergency Department. Besides, it was difficult to gauge the reasoning for blood transfusion among the different departments whether it was for objectively significant blood loss despite the stable hemodynamics, or due to symptomatic anemia. The overall acceptance of the new system should be further investigated through a qualitative study e.g. individual interviewing or group discussions to explore reasons for possible resistance to change. CONCLUSION: Changing the transfusion order can help in improving the transfusion practice in healthcare facilities. However, this strategy alone may not be effective, and further investigations into the root causes of the non-significant change in some departments are needed. Enforcing the electronic auditing system along with staff development workshops may result in better outcomes. Disclosures No relevant conflicts of interest to declare.

scholarly journals Antimicrobial Stewardship Review of Automated Candidemia Alerts Using the Epic Stewardship Module Improves Bundle-of-Care Adherence

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Natasha N Pettit ◽  
Zhe Han ◽  
Cynthia T Nguyen ◽  
Anish Choksi ◽  
Angella Charnot-Katsikas ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Intervention Group ◽  
Program Review ◽  
Post Intervention ◽  
Stewardship Program ◽  
Time To Initiation ◽  
Severe Infections ◽  
Initiation Of Therapy ◽  
The Impact

Abstract Background Antimicrobial stewardship interventions utilizing real-time alerting through the electronic medical record enable timely implementation of the bundle of care (BOC) for patients with severe infections, such as candidemia. Automated alerting for candidemia using the Epic stewardship module has been in place since July 2015 at our medical center. We sought to assess the impact of these alerts. Methods All adult inpatients with candidemia between April 1, 2011, and March 31, 2012 (pre-intervention), and June 30, 2016, and July 1, 2017 (post-intervention), were evaluated for BOC adherence. We also evaluated the impact on timeliness to initiate targeted therapy, length of stay (LOS), and 30-day mortality. Results Eighty-four patients were included, 42 in the pre- and 42 in the post-intervention group. Adherence to BOC was significantly improved, from 48% (pre-intervention) to 83% (post-intervention; P = .001). The median time to initiation of therapy was 4.8 hours vs 3.3 hours (P = .58), the median LOS was 24 and 18 days (P = .28), and 30-day mortality was 19% and 26% (P = .60) in the pre- and post-intervention groups, respectively. Conclusions Antimicrobial stewardship program review of automated alerts identifying patients with candidemia resulted in significantly improved BOC adherence and was associated with a 1.5-hour reduction in time to initiation of antifungal therapy. No significant change was observed with 30-day mortality or LOS.

scholarly journals 2102. Does Monitoring Procalcitonin Levels in Septic and Septic Shock Patients Decrease the Use of Antibiotics and Predict Length of Hospital Stay?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S710-S711
Author(s):  
Sarah E Bilbe ◽  
Ashaur Azhar ◽  
Fatima Z Brakta ◽  
Katherine N Aymond ◽  
M Jacques Nsuami ◽  
...  
Keyword(s):  
Septic Shock ◽  
Multivariate Analysis ◽  
Medical Center ◽  
Statistical Significance ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Primary Objective ◽  
Bivariate Analysis ◽  
Acute Phase Reactants ◽  
The Mean

Abstract Background Elevated levels of procalcitonin (PCT) reflect systemic inflammation associated with bacterial infection (BI). Compared with other acute-phase reactants, PCT levels more rapidly rise with BI and decline quickly as BI improves. A PCT protocol was implemented at University Medical Center New Orleans (UMCNO) in November 2017 that guided discontinuation of antimicrobial therapy in septic and septic shock patients if clinically improving with declining levels of PCT. Methods We performed a retrospective chart review of UMCNO patients 18+ years with a diagnosis of sepsis and a PCT level between January 1st, 2018 to July 31st, 2018 compared with those with sepsis and no PCT level. ICD-9/10 codes were used for diagnoses of sepsis and septic shock. The baseline characteristics including age, gender, body mass index, race and Charlston Comorbidity Index (CCI) data were collected. The primary objective was to compare the total days of antibiotic therapy (DOT) between the two groups. Secondary outcomes were broad-spectrum antibiotic DOT, patient length of stay (LOS), and all-cause 28-day mortality. SPSS was used for data analysis. P < 0.05 indicated statistical significance. Results There were 44 patients in the PCT group (PCTg) and 35 in the non-PCT group (nPCTg). The demographics are outlined in Table. The mean DOT was 6.25 days in PCTg and 10.74 days in nPCTg (P = 0.006). LOS was 7.5 days in PCTg and 14 in nPCTg (P = 0.006). The mean CCI was 2.4 in PCTg and 4 in nPCTg (P = 0.007). The all-cause 28-day mortality was 11% in PCTg and 23% in nPCTg (OR 0.4; 95% CI 0.128–1.466). On bivariate analysis, LOS was significantly associated with CCI (P < 0.05) and total DOT (P = 0.000). On multivariate analysis, LOS was only significantly associated with age (P = 0.015) and total DOT (P = 0.000) but not CCI (P = 0.811) nor PCTg (P = 0.250). Conclusion DOT was significantly shorter in the PCTg than in nPCTg. The LOS was 50% less in PCTg than in nPCTg; however, PCT monitoring did not contribute to LOS in multivariate analysis. Although the nPCTg were sicker, CCI did not correlate with LOS either. However, age and total DOT therapy remained positive predictors of LOS. Monitoring PCT levels decreased antibiotic use in septic patients. LOS, however, was not significantly affected by PCT monitoring. Disclosures All authors: No reported disclosures.

scholarly journals Reducing sitter use in acute medicine while maintaining safety and quality

2018 ◽  
Vol 9 (2) ◽  
pp. 61
Author(s):  
Delois Long ◽  
Janice Dennis
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Assessment Tool ◽  
Medical Center ◽  
Intervention Group ◽  
Post Intervention ◽  
Acute Medicine ◽  
Quality Of Patient Care ◽  
Interventional Group

Background and objective: Sitters are commonplace in acute care facilities throughout the country. Sitters are used to provide close observations and ensure safety for patients who are at risk for falls. These patients suffer from cognitive impairment, inability to follow instructions, and causing harm to themselves or others. The literature shows that one requirement for an effective sitter process is the use of an assessment tool. Sitter usage at the Louis Stokes Cleveland VA Medical Center (LSCVAMC) has escalated to the point that sitters are causing an overall shortage of nursing staff.  This shortage causes excessive overtime, staff burnout, and reduces the quality of patient care provided to non-sitter patients. The purpose of this case-control descriptive pilot study was to reduce sitter usage on an inpatient acute medicine unit, by implementing the Patient Attendant Assessment Tool (PAAT), without reducing patient safety and quality of patient care. The PAAT was developed and utilized by a Midwest hospital for data collection and to assess the need for sitters.Methods: Patients were placed into the Pre- and Post-implementation cohorts, according to the order of their admission. Pre-interventional data was collected from the study group, using the Sitter Justification Form, the 24-hour nursing report and the electronic medical record. The intervention consisted of staff education on the use of a new tool, the PAAT. Following implementation of the tool, the data was collected and analyzed using the SPSS 20 for windows (SPSS.INC), over an 8-month period.Results and conclusions: Sitter usage was reduced without reducing patient safety or quality of care, with the implementation of the PAAT. Among individuals having at least one sitter day, patients in the post intervention group, were less likely to have as many sitter shifts (n = 343, 58.0%) as compared to patients in the Pre-interventional group (n = 451, 75.9%) (Chi Square = 42.88; df = 1, p < .001). As can be seen, there was a significant decrease in the number of sitter shifts after the implementation of the PAAT, as compared to the pre-interventional group. There was a slight increase in the quality of patient care.

Improved hepatocellular carcinoma (HCC) outcomes in a public hospital setting with increased access to procedural-based therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18137-e18137
Author(s):  
Elizabeth S. Ellent ◽  
Tejas V Joshi ◽  
Lee S McDaniel ◽  
Brian C. Boulmay
Keyword(s):  
Public Hospital ◽  
Medical Center ◽  
Image Interpretation ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Locoregional Therapy ◽  
Treatment Modalities ◽  
P Value ◽  
Hospital Funding

e18137 Background: HCC is the 2nd most common cause of cancer death in the world. We investigate if increased access to various treatment modalities improved outcomes in a public hospital setting. Access to procedural-based treatments improved with development of an in hospital interventional radiology program that resulted from increased public hospital funding starting in 2013 at University Medical Center in New Orleans (UMC). Methods: A retrospective chart review was conducted to analyze 124 patients (pts) diagnosed with HCC from 2013 to 2018 at UMC to determine effect of treatment modality on outcome. Comparative analysis and Fisher’s exact test was performed using a previous study analyzing a similar population (n = 107) from 2007-2013. Results: Pts with HCC treated with transarterial chemoembolization (TACE) had an overall survival (OS) of 82.55% and 54.84% at 1 and 3 years (yr). Pts not treated with TACE had OS of 60.69% and 38.49% at 1 and 3 yr. OS in the 2007-2013 cohort at 1 year was 29%. Progression free survival (PFS) in pts treated with TACE was 52.99% and 22.66% at 1 and 3 yr. PFS in patients not treated with TACE was 58.36% and 50.28% at 1 and 3 yr. Treatment with Sorafenib (S) with or without TACE had OS of 75.84% and 48.43% at 1 and 3 yr. Pts not receiving S had an OS of 69.17% and 48.47% at 1 and 3 yr. PFS was 37.27% and 10.57% in pts treated with S at 1 and 3 yr. PFS for pts not treated with S was 67.00% and 47.02% over 1 and 3 yr. There were 140 total IR procedures which averages to 1.13 IR procedures per pt. Compared to 2007-2013 cohort, more HCC pts had TACE (10% to 56%, p < 0.001) and received S (18% to 39%,p < 0.001). Conclusions: Although PFS was not better for those pts treated with TACE (p value = 0.218), OS was statistically better with TACE (p value = 0.003). Radiologic response rates do not appear to correlate with OS benefit, perhaps due to TACE effect on image interpretation. PFS was decreased in pts treated with S (p value = < 0.0001), possibly due to its use in pts who have progressed despite TACE. The 2013-2018 cohort has superior OS compared to the 2007-2013 cohort at 1 yr. Increased access to procedural- based, locoregional therapy and S positively impacts patient outcomes.

scholarly journals Meditation Monologue can Reduce Clinical Injection-Related Anxiety: Randomized Controlled Trial

2021 ◽  
Vol 26 ◽  
pp. 2515690X2110060
Author(s):  
Dai Sugimoto ◽  
Nathalie R. Slick ◽  
David L. Mendel ◽  
Cynthia J. Stein ◽  
Emily Pluhar ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
New England ◽  
Trait Anxiety ◽  
Mobile Application ◽  
Sports Medicine ◽  
Medical Center ◽  
Controlled Trial ◽  
Intervention Group ◽  
Post Intervention ◽  
Randomized Controlled

Background. Strategies to reduce anxiety prior to injection procedures are not well understood. The purpose is to determine the effect of a meditation monologue intervention delivered via phone/mobile application on pre-injection anxiety levels among patients undergoing a clinical injection. The following hypothesis was tested: patients who listened to a meditation monologue via phone/mobile application prior to clinical injection would experience less anxiety compared to those who did not. Methods. A prospective, randomized controlled trial was performed at an orthopedics and sports medicine clinic of a tertiary level medical center in the New England region, USA. Thirty patients scheduled for intra- or peri-articular injections were randomly allocated to intervention (meditation monologue) or placebo (nature sounds) group. Main outcome variables were state and trait anxiety inventory (STAI) scores and blood pressure (BP), heart rate, and respiratory rate. Results. There were 16 participants who were allocated to intervention (meditation monologue) while 14 participants were assigned to placebo (nature sounds). There was no interaction effect. However, a main time effect was found. Both state anxiety (STAI-S) and trait anxiety (STAI-T) scores were significantly reduced post-intervention compared to pre-intervention (STAI-S: p = 0.04, STAI-T: p = 0.04). Also, a statistically significant main group effect was detected. The pre- and post- STAI-S score reduction was greater in the intervention group (p = 0.028). Also, a significant diastolic BP increase between pre- and post-intervention was recorded in the intervention group (p = 0.028), but not in the placebo group (p = 0.999). Conclusion. Listening to a meditation monologue via phone/mobile application prior to clinical injection can reduce anxiety in adult patients receiving intra- and peri-articular injections. Registration: ClinicalTrials.gov NCT02690194

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

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