OBJECTIVE We aimed to assess the feasibility, clinical accuracy, and acceptance of a hospital-wide continuous glucose monitoring (CGM) policy with electronic health record (EHR)–integrated validation for insulin dosing. RESEARCH DESIGN AND METHODS A hospital policy was developed and implemented at Stanford Health Care for using personal CGMs in lieu of fingerstick blood glucose (FSBG) monitoring. It included requirements specific to each CGM, accuracy monitoring protocols, and EHR integration. User experience surveys were conducted among a subset of patients and nurses. RESULTS From November 2022 to August 2023, 135 patients used the CGM protocol in 185 inpatient encounters. This included 27% with type 1 diabetes and 24% with automated insulin delivery systems. The most-used CGMs were Dexcom G6 (44%) and FreeStyle Libre 2 (43%). Of 1,506 CGM validation attempts, 87.8% met the %20/20 criterion for CGM-based insulin dosing and 99.3% fell within Clarke zones A or B. User experience surveys were completed by 27 nurses and 46 patients. Most nurses found glucose management under the protocol effective (74%), easy to use (67%), and efficient (63%); 80% of nurses preferred inpatient CGM to FSBG. Most patients liked the CGM protocol (63%), reported positive CGM interactions with nursing staff (63%), and felt no significant interruptions to their diabetes management (63%). CONCLUSIONS Implementation of a hospital-wide inpatient CGM policy supporting multiple CGM types with real-time accuracy monitoring and integration into the EHR is feasible. Initial feedback from nurses and patients was favorable, and further investigation toward broader use and sustainability is needed.

中文翻译：

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为住院糖尿病患者提供支持：通过 EHR 集成胰岛素剂量验证实施全院 CGM 政策


目的 我们旨在评估全院连续血糖监测 (CGM) 政策与电子健康记录 (EHR) 胰岛素剂量综合验证的可行性、临床准确性和接受度。研究设计和方法 斯坦福医疗保健中心制定并实施了一项医院政策，要求使用个人 CGM 代替指尖血糖 (FSBG) 监测。它包括针对每个 CGM、准确性监控协议和 EHR 集成的特定要求。用户体验调查是在一部分患者和护士中进行的。结果 从 2022 年 11 月到 2023 年 8 月，135 名患者在 185 次住院治疗中使用了 CGM 方案。其中 27% 患有 1 型糖尿病，24% 患有自动胰岛素输送系统。最常用的 CGM 是 Dexcom G6 (44%) 和 FreeStyle Libre 2 (43%)。在 1,506 次 CGM 验证尝试中，87.8% 符合基于 CGM 的胰岛素剂量的 %20/20 标准，99.3% 落在 Clarke 区 A 或 B 内。用户体验调查由 27 名护士和 46 名患者完成。大多数护士认为该方​​案下的血糖管理有效（74%）、易于使用（67%）和高效（63%）； 80% 的护士更喜欢住院患者 CGM，而不是 FSBG。大多数患者喜欢 CGM 方案（63%），报告与护理人员积极的 CGM 互动（63%），并且感觉糖尿病管理没有明显中断（63%）。结论 在全院范围内实施住院患者 CGM 政策，支持多种 CGM 类型，并进行实时准确监测并集成到 EHR 中是可行的。护士和患者的初步反馈是积极的，需要进一步调查以实现更广泛的使用和可持续性。