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Recommended Citation
Panice J. Oh Sugar, We are Going Down: A CNS led implementation of an evidence-based clinical pathway to standardize treatment of pediatric hypoglycemia. Evidence Based Practice poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Presentation Notes
Evidence Based Practice poster presentation at Elevating Nursing Excellence: Purpose, Profession, Passion; Advocate Health Midwest Region Nursing Research & Professional Development Conference 2024; November 13, 2024; virtual.
Abstract
Background and/or rationale:
In January 2023, there was a series of three patient safety events in patients diagnosed with hypoglycemia in the inpatient general pediatrics at Advocate Children's Hospital. Upon investigation, there was a lack of internal guidance, variations in practice between clinicians, and opportunities to standardize the definition, treatment, and monitoring of hypoglycemia.
Aim or purpose of the initiative:
The aim of the initiative was to create an evidence-based clinical pathway to standardize treatment of pediatric hypoglycemia.
Implementation plan:
Melnyk’s seven steps of evidence-based practice were used to guide this initiative. A literature search was conducted to explore pediatric hypoglycemia definitions and best practices for hypoglycemia management. Literature synthesis tables were built, and a group of key pediatric stakeholders including hospitalists, clinical nurses, endocrinologists, and pharmacists were convened to make evidence-informed decisions in the standardization of hypoglycemia treatment. An evidence-based pediatric hypoglycemia clinical pathway was created; adjustments were made to the dextrose containing products stocked on the general pediatric units; and a pediatric hypoglycemia order set was created. Providers and nurses were trained via voiced guided PowerPoint, and an SBAR was distributed to general pediatric teammates to notify them of the practice changes.
Outcomes:
In the six months following the implementation of the clinical pathway, there have been zero safety events related to hypoglycemia in our general pediatric units. Additionally, the electronic health record order set has been used on a total of seventy-five pediatric patients.
Implications:
Utilizing evidence-based methodology to answer the clinical questions surrounding hypoglycemia has resulted in improvements in patient safety and demonstrated sustained standardization in best practices.
References
Abraham, M. B., Karges, B., Dovc, K., Naranjo, D., Arbelaez, A. M., Mbogo, J., Javelikar, G., Jones, T. W., & Mahmud, F. H. (2022). ISDAP clinical practice consensus guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatric Diabetes, 23: 1322-1340. dio: 10.1111/pedi.13443.
Casertano, A., Rossi, A., Fecarotta, S., Rosanio, F. M., Morazas, C., Candia, F. D., Parenti, G., Franzese, A., & Mozzillo, E. (2021). An overview of hypoglycemia in children including a comprehensive practice diagnostic flowchart for clinical use. Frontiers in Endocrinology, 12. dio: 10.3389/fendo.2021.684011.
Gandhi, K. (2017). Approach to hypoglycemia in infants and children. Translation Pediatrics,17, 6(4): 408-420. http://dx.doi.org/10.21037/tp.2017.10.05.
Gosh, A., Banerjee, I., & Morris, A. A. M. (2016). Recognition, assessment, and management of hypoglycemia in childhood. Arch Dis Child. 101, 575-580. dio: 10.1136/achdischild-2015-308337.
Thornton PS, et al. (2016). Recommendations from the pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. Journal of Pediatrics, 167(2):238-45
UCSF Benioff Children’s Hospital. (2019). UCSF Pediatric Hospital Medicine Consortium: Consensus clinical practice guidelines for inpatient or urgent care management of acute new onset hypoglycemia in children.
White, K., Truong, L., Aaron, K., Mushtaq, N., & Thornton, P. S. (2020). The incidence and etiology of previously undiagnosed hypoglycemic disorders in the emergency department. Pediatric Emergency Care, 36(7): 322-326.
Document Type
Poster
Publication Date
11-13-2024
Oh Sugar, We are Going Down: A CNS led implementation of an evidence-based clinical pathway to standardize treatment of pediatric hypoglycemia
Background and/or rationale:
In January 2023, there was a series of three patient safety events in patients diagnosed with hypoglycemia in the inpatient general pediatrics at Advocate Children's Hospital. Upon investigation, there was a lack of internal guidance, variations in practice between clinicians, and opportunities to standardize the definition, treatment, and monitoring of hypoglycemia.
Aim or purpose of the initiative:
The aim of the initiative was to create an evidence-based clinical pathway to standardize treatment of pediatric hypoglycemia.
Implementation plan:
Melnyk’s seven steps of evidence-based practice were used to guide this initiative. A literature search was conducted to explore pediatric hypoglycemia definitions and best practices for hypoglycemia management. Literature synthesis tables were built, and a group of key pediatric stakeholders including hospitalists, clinical nurses, endocrinologists, and pharmacists were convened to make evidence-informed decisions in the standardization of hypoglycemia treatment. An evidence-based pediatric hypoglycemia clinical pathway was created; adjustments were made to the dextrose containing products stocked on the general pediatric units; and a pediatric hypoglycemia order set was created. Providers and nurses were trained via voiced guided PowerPoint, and an SBAR was distributed to general pediatric teammates to notify them of the practice changes.
Outcomes:
In the six months following the implementation of the clinical pathway, there have been zero safety events related to hypoglycemia in our general pediatric units. Additionally, the electronic health record order set has been used on a total of seventy-five pediatric patients.
Implications:
Utilizing evidence-based methodology to answer the clinical questions surrounding hypoglycemia has resulted in improvements in patient safety and demonstrated sustained standardization in best practices.
References
Abraham, M. B., Karges, B., Dovc, K., Naranjo, D., Arbelaez, A. M., Mbogo, J., Javelikar, G., Jones, T. W., & Mahmud, F. H. (2022). ISDAP clinical practice consensus guidelines 2022: Assessment and management of hypoglycemia in children and adolescents with diabetes. Pediatric Diabetes, 23: 1322-1340. dio: 10.1111/pedi.13443.
Casertano, A., Rossi, A., Fecarotta, S., Rosanio, F. M., Morazas, C., Candia, F. D., Parenti, G., Franzese, A., & Mozzillo, E. (2021). An overview of hypoglycemia in children including a comprehensive practice diagnostic flowchart for clinical use. Frontiers in Endocrinology, 12. dio: 10.3389/fendo.2021.684011.
Gandhi, K. (2017). Approach to hypoglycemia in infants and children. Translation Pediatrics,17, 6(4): 408-420. http://dx.doi.org/10.21037/tp.2017.10.05.
Gosh, A., Banerjee, I., & Morris, A. A. M. (2016). Recognition, assessment, and management of hypoglycemia in childhood. Arch Dis Child. 101, 575-580. dio: 10.1136/achdischild-2015-308337.
Thornton PS, et al. (2016). Recommendations from the pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. Journal of Pediatrics, 167(2):238-45
UCSF Benioff Children’s Hospital. (2019). UCSF Pediatric Hospital Medicine Consortium: Consensus clinical practice guidelines for inpatient or urgent care management of acute new onset hypoglycemia in children.
White, K., Truong, L., Aaron, K., Mushtaq, N., & Thornton, P. S. (2020). The incidence and etiology of previously undiagnosed hypoglycemic disorders in the emergency department. Pediatric Emergency Care, 36(7): 322-326.
Affiliations
Advocate Children's Hospital