By Kathie Hermayer, M.D.
Diabetes Management Services
MUSC received the Joint Commission Advanced Inpatient Diabetes Certification for the university hospital, Ashley River Tower, Institute of Psychiatry and Children's Hospital.
There is one other large academic institution that has this distinction, the University of Minnesota. Some university affiliate hospitals and one veterans administration hospital in Cleveland, Ohio, have achieved this award. MUSC is approximately the 38th hospital in the nation to gain this distinction.
The Joint Commission Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Certification Standards. Diabetes currently affects 25.8 million people in the nation and another 79 million Americans are estimated to have pre-diabetes.
At MUSC in fiscal year 2010, there were 34,442 hospital discharges and in 2011 (up to April), there were 28,044 hospital discharges. On a daily basis at MUSC medical center, there are 130 to 150 patients with a diagnosis of diabetes. The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, the medical record identifies diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia and patient education on self-management of diabetes.
Achievement of certification regarding inpatient diabetes care means that MUSC has the critical elements to attain success in the care of patients with diabetes. It may be used as a designation for the community that MUSC delivers quality care to patients.
Ultimately, maintaining compliance with these national standards and performance measurement tools may assist with acquiring contracts from employers and purchasers associated with controlling costs and enhancing productivity. This is a distinction that will continue to inspire MUSC to excel in offering safe and effective patient care of the highest quality and value.
Key individuals, areas involved
The Joint Commission Certification for Inpatient Diabetes Care was accomplished by a multidisciplinary approach involving many areas.
Key individuals involved in the process from the Center for Clinical Effectiveness and Patient Safety are: Patrick Cawley, M.D., hospital executive medical director, Mary-Eliese Merrill, R.N., director of clinical effectiveness, Christopher Rees, director of quality and patient safety, Pam Arnold, CDE (certified diabetes educator), program manager for the Diabetes Management Service and vice chair of the Hospital Diabetes Task Force, Angela Strickland, R.N., CDE, and Amy Hutto, R.N., CDE.
Other important areas of input included nursing services, pharmacy, dietary services, laboratory medicine, information technology, anesthesia, and representatives from MUSC university hospital, Ashley River Tower, Children's Hospital, and Institute of Psychiatry. Heather Kokko, PharmD, director of Pharmacy Services; Brian McKinzie, PharmD; Yusheng Zhu, Ph.D.; James Madory, DO; and Nina Epps, Pathology and Lab Services; and registered dietitians Mary Basel and Ashleigh Ricevuto from Dietetic Services, all provided valuable input in this process.
Special thanks to Louis Luttrell, M.D., Ph.D., division director of endocrinology, and members of the Diabetes Management Service: Drs. Soonho Kwon, Jyotika Fernandes and Beatrice Hull, Nicoleta Sora, Hussein Rajab, Dorothy Kodzwa, Linda Meyers, Carnina Charles, Kristine Parker, and the DMS mid-level providers: Sarah Kimble, P.A., Kelly Taylor, P.A., and Meredith Wince, N.P. Also thanks to Drs. Bill Moran, Rogers Kyle, Danielle Scheurer, the MUSC Internal Medicine Program and the MUSC Hospitalist Program. Collaborative efforts occurred with Drs. David Cole, Chairman of the Department of Surgery, Deborah Bowlby, director of Pediatric Endocrinology, Stephen McLeod-Bryant, service line director for psychiatry, Institute of Psychiatry, and Jill Mauldin, service line director for Women's Services.
Additionally, of importance are members of the Hospital Diabetes Task Force who have given their input and guidance on diabetes issues on a monthly basis since 2003. Jack Feussner, M.D., was a source of inspiration for his visionary goals and foresight regarding the care of patients with diabetes.
Thanks to MUSC's Joint Commission team: Lois Kerr, Kathy Wade, and Terri Ellis, who always brought relevance to goals for improving diabetes care.
Overall, there was one recommendation for improvement which involved hypoglycemia recheck in 30 minutes from initial blood glucose (BG), BG less than 70 mg/dL.