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Reducing iatrogenic hypoglycemia in hyperkalemic patients treated with insulin therapy with a modified hyperkalemia order set at The Queen’s Medical Center

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Title:Reducing iatrogenic hypoglycemia in hyperkalemic patients treated with insulin therapy with a modified hyperkalemia order set at The Queen’s Medical Center
Authors:Lui, Vanessa Hing Yan
Contributors:Albright, Cheryl (advisor)
Nursing (department)
Keywords:Nursing
hyperkalemia
hyperkalemia order set
hypoglycemia
insulin
show 1 moreThe Queen's Medical Center
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Date Issued:2019
Publisher:University of Hawai'i at Manoa
Abstract:Iatrogenic hypoglycemia as a result of hyperkalemia treatment is a common and potentially lethal complication. People with renal impairment are at an increased risk for hyperkalemia and hypoglycemia due to a decrease in glomerular filtration rate. During 2017 there were 87 episodes of hypoglycemia associated with hyperkalemia treatment at The Queen’s Medical Center. The Academic Center for Excellence Star Model of Knowledge Transformation was used as the conceptual framework for the development of a standardized order set for providers and nurses that was implemented throughout The Queen’s Health Systems to reduce hypoglycemic episodes during hospitalization for hyperkalemia treatment.
The target population was patients admitted and treated for hyperkalemia with insulin and dextrose and the percentage that had a hypoglycemic event within six hours of insulin administration. Methods to evaluate outcomes were based on data reports and manual electronic medical record review and analysis. This new hyperkalemia order set replaced the current hyperkalemia order set in the EPIC/Care*Link systems and medication administration record, included more efficient and timely blood glucose checks. The new order set was successfully implemented on October 06, 2018.
Data was collected for two months, and during this period, 19 episodes of hypoglycemia were identified, and 14 treatments were implemented using the new order set. In comparison to the 12 month data, the number of hypoglycemic episodes increased slightly from 17% to 22%. In the two-month data collection period, provider participation for computerized hyperkalemia order set entry increased by 11%, from 62% in calendar year 2017 to 73%. Although, not a formal objective in this project, the time differences for blood glucose checks and identification of hypoglycemia incidences observed between order set and non-order set driven treatment were noted. Order-set driven treatments that were used precisely and correctly as indicated in the revised protocol in the two months’ time frame showed efficient identification and treatments of hypoglycemia.
Description:D.N.P. Thesis. Ph.D. Thesis. University of Hawaiʻi at Mānoa 2019
Pages/Duration:32 pages
URI:http://hdl.handle.net/10125/63224
Rights:All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections: D.N.P. - Nursing


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