Glycemic Control Goal

Definition

Glycemic control has been shown to decrease mortality in severely septic patients in clinical trials. However, overly aggressive protocols may lead to hypoglycemia, which must be avoided.

Compliance with this bundle element is defined as the percent of patients with severe sepsis and/or septic shock for whom serum glucose is maintained greater than the lower limit of normal and with a median value < 150 mg/dL (8.3 mmol/L) over the first 24 hours.

Note: If the median glucose is < 150 but episodes of hypoglycemia occurred along the way, no credit is assigned for this indicator.  Use the Monthly Measures Worksheet in conjunction with the Individual Chart Measurement Tool to assess whether episodes of hypoglycemia occur. Teams are encouraged to adjust their glucose protocols so that hypoglycemia, which can be fatal, is usually prevented. 

Numerator: Number of patients with serum glucose maintained greater than the lower limit of normal and with a median value < 150 mg/dl (8.3 mmol/L) over the first 24 hours following presentation with severe sepsis and/or septic shock

Denominator: Number of patients presenting with severe sepsis and/or septic shock

Goal

Increase the number of patients with severe sepsis and/or septic shock who achieve glucose control and avoid hypoglycemia to 100 percent of cases. 

Data Collection Plan

Data is collected for this measure on each individual patient using the Individual Chart Measurement Tool. This can be done concurrently or retrospectively as detailed here.

Note: To assist calculation of the median glucose value over 24 hours, there is an optional Median Glucose Calculation Tool that allows the various values to be arranged in order and describes how to calculate the median value. Once done with this tool, record the result on the Individual Chart Measurement Tool.

Once all the Individual Chart Measurement Tools have been collected for the month, use the Monthly Measurement Worksheet to integrate the data by combining the results of all the Individual Chart Measurement Tools.

At the end of each section on the Monthly Measurement Worksheet you will find a line designated “Numerator” and a line designated “Denominator,” which are ready for input into the pre-configured Improvement Tracker for the measure.

Related Changes

Maintain Adequate Glycemic Control

Sample Graph

Use IHI's Improvement Tracker to enter, save, and graph your team's data.