Nurse-Driven Process Reduces Hypoglycemic Episodes

Aug 01, 2019

Added to Collection

Study in Critical Care Nurse reports how a nurse-led initiative at Stamford Hospital reduced episodes of hypoglycemia, using a root cause analysis format

ALISO VIEJO, Calif. – Aug. 1, 2019 – A nurse-directed initiative to examine the root causes of hypoglycemic episodes resulted in a sustained reduction in hypoglycemia among critically ill patients at Stamford Hospital in Connecticut, according to a study published in the August issue of Critical Care Nurse (CCN).

Critical illness can cause blood glucose levels to fluctuate, making glycemic control a challenge in hospitalized patients. Even with frequent monitoring and patient assessments, the use of insulin therapy may result in lowering blood glucose levels too much.

Hypoglycemia, or blood glucose levels below 70 mg/dl, remains a common, and frequently preventable, patient safety concern, despite the development of evidence-based protocols and more informed guidelines for glycemic control. The Joint Commission recommends that all episodes of hypoglycemia be evaluated with a root cause analysis (RCA) to identify the underlying causes so the most effective solutions can be identified and implemented.

Reducing Hypoglycemia in Critical Care Patients Using a Nurse-Driven Root Cause Analysis Process” reports how an interdisciplinary team at Stamford Hospital used the RCA approach to analyze in real time, each episode of hypoglycemia.

The nurse-driven RCA of hypoglycemic episodes resulted in a sustained reduction in hypoglycemia as well as improvement in other glucose metrics. Both the number of patients with and without diabetes who had a hypoglycemic event decreased, with corresponding decreases in the percentage of blood glucose values.

Co-author Sally O. Gerard, DNP, RN, CDE, CNL, is an inpatient diabetes educator at Stamford Hospital and an associate professor of nursing at Fairfield University, Connecticut.

“By finding a process to drill down to a new level of detail regarding the variety of factors that can lead to hypoglycemia, nurses were able to examine their own practice and make relatively minor adjustments that produced positive results,” she said. “The model of nurse accountability for data collection and analysis represents the current culture of the expanding roles of bedside nurses.”

The RCA intervention encompassed 2,608 patients admitted over a 28-month period from Nov. 1, 2013, to Feb. 29, 2016. These patients were compared with a preintervention cohort of 2,429 patients. Both groups were then compared with a “continuation” cohort of 500 patients to determine the sustained effects of the intervention.

Nurses collaborated with the interdisciplinary team to develop a one-page RCA worksheet to evaluate more fully the conditions surrounding each hypoglycemic episode. The form documented individual risk factors, blood glucose levels before the event, relevant insulin administration, diet changes, nursing interventions and other factors that may have been related.

After a patient experienced a hypoglycemic event, the nurse completed the form, detailing episodes as they occurred. Monthly analysis of RCA forms allowed the staff to glean insights and identify commonalities.

The processes to prevent hypoglycemia that began during the RCA initiative were incorporated into the unit practices, and the improved data related to the project remained after the implementation phase.

In addition, the multiple approaches to glycemic control and safety allowed for additional glycemic metrics that supported positive patient outcomes, such as decreased mean blood glucose levels and glucose variability.

As the American Association of Critical-Care Nurses’ bimonthly clinical practice journal for high-acuity and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients.

Access the article abstract and full-text PDF by visiting the CCN website at

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high-acuity, progressive and critical care settings. CCN enjoys a circulation of more than 120,000 and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 with 400 members, the American Association of Critical-Care Nurses (AACN) is now the world’s largest specialty nursing organization. In 2019, AACN celebrates 50 years of acute and critical care nursing excellence, serving more than 120,000 members and over 200 chapters in the United States. The organization remains committed to its vision of creating a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. During its 50th anniversary year, AACN continues to salute and celebrate all that nurses have accomplished over the last half century, while honoring their past, present and future impact on the evolution of high-acuity and critical care nursing.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000;;;