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Our take: High-reliability healthcare systems should use multiple methods for blood glucose surveillance to promptly intervene on persistent hyperglycemia. The EHR should provide easy-to-use, customizable views of patient blood glucose levels across multiple types of groups: dashboards for entire facilities, geographical units, service lines, provider teams, as well as individual patient data.
Our take: Good adherence with these guidelines emphasizes the need for tools that support organizations in adjusting their protocols in such a way that they can minimize hypoglycemia. Different protocols might work better for different patient populations. In addition, the flexibility to pursue tighter glycemic ranges in carefully monitored patient populations also requires protocol flexibility. High-reliability healthcare organizations should implement a system that provides this flexibility.
The panel included a table in the guidelines that sets out the minimum requirements for “Explicit Decision Support Tools for Glycemic Management.” The key criteria include the following: that the bedside clinician knows exactly what to do with each blood glucose level and that those actions are reproducible across patients with the same situation; that the system uses two or more patient-specific input variables and produces two or more output variables; and that the system allows the clinician to agree or disagree with the system’s recommendation.
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