Pharmacist-led diabetes stewardship program improves patients' lives

Abstract

Five years ago, the University of Nebraska Medical Center (UNMC) in Omaha started a diabetes stewardship pharmacist program led by Jon Knezevich, PharmD. Since the beginning, the program has improved patients’ glycemic control and resulted in cost savings for the health care system through technological and process advancements. Between January 2015 and June 2020, UNMC reported significant reductions in hypoglycemic (<70 mg/dL) events in both critical and noncritical care units—about 65% and 50%, respectively. “This translates to an estimated cumulative length of stay reduction of 0.46 days and greater than $690,000 in cost avoidance annually, along with an additional $150,000 in cost savings from formulary management strategies,” said Knezevich. Specially trained pharmacists at UNMC monitor blood glucose levels in hospitalized patients to help maintain glycemic control. “While diabetes may not be the reason a patient is hospitalized, it often contributes to complexity in managing their health care during their inpatient stay,” said Knezevich. There is considerable evidence to suggest that regardless of cause, hyperglycemia among hospitalized patients with or without diabetes is often associated with poor outcomes. According to a June 2009 consensus statement in Diabetes Care from the American Association of Clinical Endocrinologists and the American Diabetes Association, patients with diabetes are more likely to be hospitalized and have longer hospital stays than patients without diabetes. How pharmacists can improve the lives of patients with diabetes at their institutions□Implement a team-based approach to achieve positive outcomes for the high number of patients with diabetes.□Recognize that administrative support is vital to champion initiatives surrounding improvement in glycemic outcomes.□Identify major objectives that are measurable at the onset and throughout project implementation to demonstrate achievement of institutional goals.This is a marathon, not a sprint! Empowering colleagues across disciplines helps ensure buy-in and accountability.—Jon Knezevich, PharmD □Implement a team-based approach to achieve positive outcomes for the high number of patients with diabetes.□Recognize that administrative support is vital to champion initiatives surrounding improvement in glycemic outcomes.□Identify major objectives that are measurable at the onset and throughout project implementation to demonstrate achievement of institutional goals. This is a marathon, not a sprint! Empowering colleagues across disciplines helps ensure buy-in and accountability. —Jon Knezevich, PharmD The UNMC program has minimized glycemic excursions—hypoglycemia and hyperglycemia—during a patient's hospital stay, said Knezevich, thus reducing health care waste that may have resulted due to blood glucose abnormalities. According to Knezevich, many factors have played a role in the program's ongoing success. Major ones are educational and training efforts to help pharmacists feel empowered to make clinical decisions, use of technological advancements to streamline workflow processes, and interdisciplinary communication within the organization to promote collaboration hospital-wide. “I am extremely proud of our commitment to patient care, including the coordinated efforts our pharmacy service line has contributed to improving blood glucose control,” said Knezevich. “This program illustrates the impact pharmacists can have when working collaboratively with the health care team.” Other factors that have contributed to the program's success include □Development of an acute glycemic management credentialing competency training program to help pharmacists feel more confident in making clinical decisions.□Creation of a novel dashboard using the hospital's electronic health record system for timely decision support to allow for decentralized pharmacy services.□Identification of high-risk medications in the updated system to require lab monitoring for medications to ensure appropriate therapy regimens. In addition, the hospital reviewed and revised the inpatient formulary and began using larger (10 mL) multiuse insulin vials, which led to about $10,000 in cost savings over a 1-month period. While it was not a quick win for UNMC's diabetes stewardship pharmacist program, with perseverance, collaboration, and determination, other stewardship programs can have similar or even greater impacts. As the medication experts, pharmacists should feel empowered to use their knowledge and training to help patients maximize their health outcomes. Showing organizations and other providers that pharmacists bring considerable value to the health care system helps pharmacists do their best work, while saving costs along the way. “Although our rates of hypoglycemia have been substantially reduced since program implementation, we would like to avoid all episodes,” said Knezevich.