This measure assesses the proportion of encounters of patients 18 years of age or older at admission, who were administered at least one hypoglycemic medication during the encounter, who suffer the harm of a severe hypoglycemic event during the encounter. Harm (numerator) is defined as a laboratory or point-of-care (POC) test for blood glucose with a result less than 40 mg/dL, where the hypoglycemic medication was given within the 24 hours prior to the start of the low blood glucose event (and administered during the encounter). Only one severe hypoglycemic event is counted per encounter.
All encounters when the patient is 18 years of age or older at the start of the encounter, and at least one hypoglycemic medication was administered during the encounter. Measure includes instances of administration of hypoglycemic medications in the emergency department or in observation status at the start of an inpatient admission when assessing inclusion of encounters in the measure denominator.
Denominator: Equals Initial Population
All encounters which include:
1. A severe hypoglycemic event during the encounter, defined as a test (laboratory or point-of-care (POC)) for blood glucose with a result less than 40 mg/dL;
2. A hypoglycemic medication administration within 24 hours prior to the start of the severe hypoglycemic event (and that was during the encounter);
3. No subsequent repeat test for blood glucose with a result greater than 80 mg/dL within five minutes of the start of the initial low blood glucose test.
Only the first qualifying severe hypoglycemic event is counted in the numerator, and only one severe hypoglycemic event is counted per encounter. The 24-hour and 5-minute timeframes are based on the time the blood glucose was drawn, as this reflects the time the patient was experiencing that specific blood glucose level.
This measure focuses on severe hypoglycemia as an outcome in the hospital inpatient setting. Hypoglycemia events in the hospital are among the most common adverse drug events. In 2004 an estimated 888,000 adverse drug events occurred among hospitalized Medicare patients in the United States (Classen et.al., 2010; National Quality Forum, 2010). In a recent study published by the Office of the Inspector General (OIG), adverse drug events represent one-third of all adverse events in hospitals among Medicare patients; of those events, hypoglycemia represented the third most common adverse drug events (Office of the Inspector General, 2010).
Rates of inpatient hypoglycemia events are considered an indicator of the quality of care provided by a hospital. Severe hypoglycemia events are largely avoidable by careful use of antihyperglycemic medication. Moreover, the rate of severe hypoglycemia varies across hospitals indicating an opportunity for improvement in care. The Agency for Healthcare Research and Quality (AHRQ) identified insulin and other hypoglycemic agents as high alert medications and associated adverse events to be included as a measure in the Medicare Patient Safety Monitoring System (MPSMS) (Classen et al., 2010). Hypoglycemic events are an adverse outcome that can cause patients to experience drowsiness, confusion, anxiety, irritability, sweating, weakness, increased heart rate, uncontrollable trembling, as well as loss of consciousness and seizure (Classen et al., 2010; American Diabetes Association, 2015).