Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients.
Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients.
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护理点血糖测量误差高估了危重患者的低血糖发生率。
DOI：
10.1002/dmrr.2575
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Wisse,BrentE
中科院分区：
文献类型：
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作者：
Nya-Ngatchou,Jean-Jacques;Corl,Dawn;Onstad,Susan;Yin,Tom;Tylee,Tracy;Suhr,Louise;Thompson,RachelE;Wisse,BrentE
背景低血糖与危重病患者的发病率和死亡率有关，许多医院都有将低血糖发生率降至最低的计划。最近的研究已经建立了低血糖患者日数作为一个关键的指标，并发布了基于护理点血糖数据的住院患者低血糖发生率基准，尽管这些值容易出现测量误差。方法对2010年至2011年期间在哈博维尤医疗中心重症监护病房(ICU)住院的所有患者进行了一项回顾性的队列研究，以评估质量改进计划，以减少不适当的护理点血糖测量错误的记录。结果质量改进干预措施将低血糖的测量误差从2010年的31%降至2011年的14%(p<； 0.001)，并将观察到的低血糖发生率从4.3%降至3.4%(p<； 0.001)。低血糖事件经常反复发生或延长(约40%)，这些事件不能通过低血糖患者日指标确定，而低血糖患者日指标也可能与大量极低风险或最低监测的患者日混淆。结论护理点血糖测量错误的记录可能高估了ICU的低血糖发生率，并可以通过质量改进努力来减少。目前使用的低血糖患者日指标不评估可能更有可能导致患者伤害的复发或延长事件。目前定义的监测病人日可能不是确定住院患者低血糖风险的最佳分母。版权所有©2014 John Wiley&Sons，Ltd.
BackgroundHypoglycaemia is associated with morbidity and mortality in critically ill patients, and many hospitals have programmes to minimize hypoglycaemia rates. Recent studies have established the hypoglycaemic patient‐day as a key metric and have published benchmark inpatient hypoglycaemia rates on the basis of point‐of‐care blood glucose data even though these values are prone to measurement errors.MethodsA retrospective, cohort study including all patients admitted to Harborview Medical Center Intensive Care Units (ICUs) during 2010 and 2011 was conducted to evaluate a quality improvement programme to reduce inappropriate documentation of point‐of‐care blood glucose measurement errors. Laboratory Medicine point‐of‐care blood glucose data and patient charts were reviewed to evaluate all episodes of hypoglycaemia.ResultsA quality improvement intervention decreased measurement errors from 31% of hypoglycaemic (<70 mg/dL) patient‐days in 2010 to 14% in 2011 (p< 0.001) and decreased the observed hypoglycaemia rate from 4.3% of ICU patient‐days to 3.4% (p< 0.001). Hypoglycaemic events were frequently recurrent or prolonged (~40%), and these events are not identified by the hypoglycaemic patient‐day metric, which also may be confounded by a large number of very low risk or minimally monitored patient‐days.ConclusionsDocumentation of point‐of‐care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient‐day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient‐day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk. Copyright © 2014 John Wiley & Sons, Ltd.