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Published on: June 11, 2012
Hypoglycemia adverse events in PICUs and cardiac ICUs: differentiating preventable and nonpreventable events*
Paul L Shea1, Michael C Spaeder, Puneet Sayal
11Department of Pediatrics, Section of Critical Care, St Christopher's Hospital for Children, Philadelphia, PA. 2Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA. 3Department of Critical Care Medicine, Children's National Medical Center, Washington, DC. 4Department of Pediatrics, The George Washington University School of Medicine, Washington, DC. 5Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
Insights
Preventable hypoglycemia adverse events are linked to patients receiving only parenteral nutrition. In cardiac intensive care units, events are more likely to be preventable during weekends and holidays.
Area of Science:
- Pediatric critical care medicine
- Patient safety
- Clinical informatics
Background:
- Hypoglycemia adverse events (AEs) pose risks in pediatric intensive care units (PICUs) and cardiac intensive care units (CICUs).
- Effective detection and characterization of hypoglycemia AEs are crucial for improving patient safety.
- Understanding factors contributing to preventable hypoglycemia is key to developing targeted interventions.
Purpose of the Study:
- To utilize an adverse event detection system to identify, characterize, and categorize preventable versus nonpreventable hypoglycemia AEs.
- To analyze clinical and demographic variables associated with preventable and nonpreventable hypoglycemia AEs in PICUs and CICUs.
Main Methods:
- Retrospective observational study design.
- Analysis of all hypoglycemia triggers generated over a 3-year period in a tertiary pediatric hospital's PICU and cardiac ICU.
- Investigation of electronic health record-driven surveillance data to classify hypoglycemia events as true AEs and determine preventability.
Main Results:
- 197 hypoglycemia AEs occurred in 90 patients; 30-36% were preventable.
- Events were more likely to be preventable in patients receiving sole parenteral nutrition (OR 9.5).
- In cardiac ICUs, events on weekends/holidays were more likely to be preventable (OR 11.6).
Conclusions:
- Preventable hypoglycemia AEs are associated with sole parenteral nutrition in PICUs and CICUs.
- Weekend and holiday timing is linked to preventable hypoglycemia AEs specifically within the cardiac ICU.
- These findings highlight the need for enhanced surveillance and targeted interventions for hypoglycemia prevention in vulnerable patient populations.
Objectives:
To describe the use of an adverse event detection system to identify, characterize, and categorize preventable versus nonpreventable hypoglycemia AEs in PICUs and cardiac ICUs.
Design:
Retrospective observational study.
Setting:
PICU and cardiac ICU of a tertiary pediatric hospital.
Subjects:
All hypoglycemia triggers generated over a 3-year period.
Interventions:
All hypoglycemia triggers generated via an electronic health record-driven surveillance system were investigated to determine if they represented a true adverse event and if that event was preventable or nonpreventable. Clinical and demographic variables were analyzed to identify characteristics of patients who developed a preventable or nonpreventable hypoglycemia adverse event.
Measurements And Main Results:
There were 197 hypoglycemia adverse events in 90 patients. Thirty percent of the adverse events in the PICU and 36% of the adverse events in the cardiac ICU were characterized as preventable. Of the adverse events, 118 (59.9%) necessitated an intravenous dextrose bolus. No adverse events were associated with reporting of symptoms of hypoglycemia including apnea, altered mental status, or seizures. Events were more likely to be preventable (p < 0.001) if the patient was receiving only parenteral sources of nutrition (intravenous fluids or total parenteral nutrition). Controlling for weekends and holidays, adverse events associated with sole parenteral nutrition source had an increased odds ratio of 9.5 (95% confidence interval: 2.8-31.9) of being preventable. Stratifying by ICU, cardiac ICU events occurring on a weekend or holiday were more likely to be preventable (p = 0.001). Stratifying by unit and controlling for parenteral nutrition source, adverse events in the cardiac ICU occurring on weekends or holidays had an increased odds ratio of 11.6 (95% confidence interval: 2.7-50.2) of being preventable.
Conclusions:
Preventable hypoglycemia adverse events are associated with patients receiving sole parenteral sources of nutrition in both the PICU and cardiac ICU. In the cardiac ICU, there is an association between weekend and holiday time periods and the development of preventable hypoglycemia adverse events.
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