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Poor Patient Compliance May Cause Hypoglycemia in Hospital

March 14, 2008
Written by: , Filed in: Practice Management
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One defined ‘never event’ is serious patient disability associated with
hypoglycemia, the onset of which occurs while the patient is being care for in
a health care facility. The preventability of this event is somewhat
controversial.

‘Never events’ are serious medical errors made while providing health care to
inpatients and outpatients. According to the National Quality Forum, ‘never
events’ are preventable, and one such item is serious patient disability
associated with hypoglycemia, the onset of which occurs while the patient is
being cared for in a health care facility. The preventability of this event is
somewhat controversial because the patient can have a significant impact on
this medical error.

The most common scenario for this problem is when the patient is NPO (nothing
per os or by mouth) before a procedure. Although the patient who normally
receives insulin has restricted intake, their insulin is not held. As a
result, the patient’s blood sugar level drops to a number that is very
uncomfortable for everyone, and then additional care must be provided.
Usually, the patient does not suffer any significant problems, but there are
other situations in which the patient ends up with long-term problems.

Again, this is a somewhat controversial ‘never event’ because patients are
human and can be noncompliant. They do not always tell the health care team
about their situation. For instance, some patients come to the hospital and
use their own insulin in addition to what is being administered in the
hospital.

At that point, the error becomes focused on communication. Patients need to
understand why it is important to be truthful about what they have taken and
about what they have and have not eaten. The health care team must make sure
that they are on top of what they are giving the patient–that the patient is
receiving the right insulin at the right time and at the right dose.

Therefore, physicians must be familiar with the various insulin protocols.
Insulin preparations have changed so much in the last 10 years that physicians
writing the orders have to practically be experts in diabetes management to
ensure sure that the insulin being provided to the patient meets his or her
needs and keeps blood sugar levels where they need to be throughout the day.

Errors can be made in just choosing the wrong kind of insulin. Pharmacists are
also well aware of this, but the order writing starts with the physicians.
Often, other members of the health care team do not know the patient well
enough to question whether the insulin choice is correct. Once the rest of the
team gets to know the patient, there can be more input, but typically the
attending physician is the one who knows the patient best.

Reference:
Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events:
Serious Patient Disability Associated With Hypoglycemia

One defined 'never event' is serious patient disability associated with hypoglycemia, the onset of which occurs while the patient is being care for in a health care facility. The preventability of this event is somewhat controversial. 'Never events' are serious medical errors made while providing health care to inpatients and outpatients. According to the National Quality Forum, 'never events' are preventable, and one such item is serious patient disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility. The preventability of this event is somewhat controversial because the patient can have a significant impact on this medical error. The most common scenario for this problem is when the patient is NPO (nothing per os or by mouth) before a procedure. Although the patient who normally receives insulin has restricted intake, their insulin is not held. As a result, the patient's blood sugar level drops to a number that is very uncomfortable for everyone, and then additional care must be provided. Usually, the patient does not suffer any significant problems, but there are other situations in which the patient ends up with long-term problems. Again, this is a somewhat controversial 'never event' because patients are human and can be noncompliant. They do not always tell the health care team about their situation. For instance, some patients come to the hospital and use their own insulin in addition to what is being administered in the hospital. At that point, the error becomes focused on communication. Patients need to understand why it is important to be truthful about what they have taken and about what they have and have not eaten. The health care team must make sure that they are on top of what they are giving the patient--that the patient is receiving the right insulin at the right time and at the right dose. Therefore, physicians must be familiar with the various insulin protocols. Insulin preparations have changed so much in the last 10 years that physicians writing the orders have to practically be experts in diabetes management to ensure sure that the insulin being provided to the patient meets his or her needs and keeps blood sugar levels where they need to be throughout the day. Errors can be made in just choosing the wrong kind of insulin. Pharmacists are also well aware of this, but the order writing starts with the physicians. Often, other members of the health care team do not know the patient well enough to question whether the insulin choice is correct. Once the rest of the team gets to know the patient, there can be more input, but typically the attending physician is the one who knows the patient best. Reference: Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events: Serious Patient Disability Associated With Hypoglycemia [text_ad]
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