Rush University guidelines and protocols for the management of hyperglycemia in hospitalized patients: elimination of the sliding scale and improvement of glycemic control throughout the hospital.

The management of inpatient hyperglycemia has received much recent attention because of an expanding literature supporting the benefits of quality improvement and the creation of guidelines in this area. The authors began a process in 2002 to create modern protocols for glycemic control with intravenous insulin in their intensive care units and with subcutaneous basal-prandial insulin in all of their non-intensive care units. In this report, they describe both the process employed and the current protocols they are using. They also describe the process, perpetually ongoing, for educating nurses and residents in a large academic medical center. The annual cycle of senior residents passing on the regular insulin sliding scale to first-year interns and students can be broken. The hospital ward can be a valuable setting in which to teach basal/prandial insulin protocols, which will readily translate into the outpatient clinic. Where better to teach the importance and real-time usefulness of HbA1c than on the inpatient ward of a teaching hospital? Protocols to prevent and treat hypoglycemia can also be taught and widely accepted, hospital insulin formularies can be streamlined, and modern information technology can be used to track and improve multiple metrics of care for inpatients with hyperglycemia. The inpatient encounter with diabetic care can be a golden window of opportunity for patient as well as physician and nurse education.