Pharmacists' Impact on Glycemic Control Among Surgical Patients at a Large Academic Institution.

Abstract

Hyperglycemia has been associated with poor outcomes in several large studies. Repeated or prolonged hyperglycemia has been linked to an increased risk of adverse outcomes, including limb amputation, acute myocardial infarction, prolonged length of hospital stay, and increased mortality, in various populations (1–4). Suspension of oral antidiabetic agents in anticipation of procedures for which oral nutritional intake is contraindicated, along with insulin resistance resulting from acute illness, often leaves patients without proper glucose control when admitted to the hospital. The National Quality Forum (NQF), a not-for-profit organization, supports evidence-based consensus standards to achieve better health outcomes. NQF endorses many Centers for Medicare & Medicaid Services (CMS) quality measures, which often affect reimbursement. This attempts to hold institutions accountable for providing quality patient care. Among these measures are standards focusing on patients presenting with heart failure, acute myocardial infarction, and pneumonia. Currently, serum glucose–related CMS measures have been developed but are not yet implemented; these measures include the average percentage of hyperglycemic and hypoglycemic hospital days. More information about these measures can be found on the NQF’s website (http://www.qualityforum.org). With an increasing focus on quality and outcomes measures, the need exists to quickly identify hyperglycemic patients and initiate appropriate interventions. Optimization of insulin therapy requires careful assessment of multiple patient-specific factors, including nutritional intake, prior insulin requirements, and concomitant medications (5). With knowledge of drug therapy, drug preparation, and dispensing, pharmacists are well situated to be involved in many aspects of glycemic management in the inpatient setting (6). Clinical pharmacist participation in rounds and surveillance of prescribing patterns can optimize serum glucose management (5–7). This single-center, prospective, observational cohort study aimed to evaluate the impact of dedicated clinical pharmacy services on serum glucose management among high-risk surgical inpatients. At the University of California, San Francisco (UCSF) …