SAT-557 - Reducing Inpatient Hypoglycemia through Standardized Nursing Education and Protocol Adherence: A Resident-Led Quality Improvement Initiative

Aim:

Hypoglycemia is a common inpatient complication requiring timely treatment, repeated glucose monitoring, and standardized documentation. This quality improvement initiative aimed to reduce recurrent inpatient hypoglycemic events by at least 30% over six months, with a secondary objective of improving standardized hypoglycemia documentation through targeted nursing education.

Methods:

We conducted a Plan-Do-Study-Act quality improvement initiative involving adult hospitalized patients in medical, surgical, and intensive care units at a community hospital. Hypoglycemia was defined as capillary blood glucose < 70 mg/dL, with recurrent hypoglycemia defined as >2 events during a single hospitalization. The intervention consisted of targeted nursing education on hypoglycemia recognition, management, and standardized electronic documentation. Monthly chart reviews were conducted by the medicine residents to track predefined outcome and process measures, and unit-level feedback was provided to bedside nurses. Baseline data were collected from August 2024 to January 2025, with post-intervention data analyzed from February to June 2025. Trends were assessed longitudinally to evaluate intervention impact.

Results:

Following the implementation of nursing education in late January 2025, monthly hypoglycemic event rates among hospitalized patients with diabetes decreased sustainably from 63 events among 596 diabetic patients (10.5%) in January 2025 to 28 events among 479 diabetic patients (5.8%) in June 2025, representing an absolute reduction of 35 events, an absolute rate reduction of 4.8 percentage points, and a relative reduction of approximately 45%.
Patients with pre-diabetes or diabetes accounted for most hypoglycemic events both pre- and post-intervention; however, the proportion decreased from 92% pre-intervention to a range of 68–80% post-intervention. Process measures improved, including completion of a dedicated hypoglycemia event note (+16.3%) and appropriate provider escalation (+10.6%).

Conclusion:

The resident-led, multidisciplinary quality improvement initiative demonstrated a sustained reduction in inpatient hypoglycemic events following implementation of standardized nursing education and improved institutional protocol adherence. Although overall event frequency declined, hypoglycemia burden per patient remained stable, highlighting the role of patient-specific risk factors, including individualized risk stratification, medication adjustment, and proactive prevention strategies. Ongoing education, continued monitoring, and integration of the multidisciplinary diabetes oversight committee will be critical to sustaining and expanding these improvements in inpatient glycemic management.

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