Stem cell transplant and graft versus host disease: designing and implementing a steroid-induced hyperglycemia tool kit.

PURPOSE: Patients receiving glucocorticoids for acute graft versus host disease (GVHD) after allogeneic hematopoietic stem cell transplant (HSCT) are at risk for developing hyperglycemia and subsequent complications. The primary purpose of this project was to reduce time to medical intervention for steroid-induced hyperglycemia through the implementation of a tailored tool kit for HSCT clinicians.

METHODS

An interdisciplinary team conducted a four-phase project: (1) a baseline chart audit and survey of advanced practice providers (APPs), (2) development of a tool kit and educational materials, (3) education of the HSCT team, and (4) post tool kit implementation chart audit and APP surveys.

RESULTS

Patients at baseline (N = 15) and post tool kit implementation (N = 8) were diagnosed with acute GVHD with ≥ 0.5 mg/kg/day prednisone and subsequent steroid-induced hyperglycemia. The average number of days to medical intervention was 46 at baseline, reduced to 10 days at 3 months and 9 days at 6 months post tool kit implementation. Metrics used to evaluate changes in APP practice noted an increase in hemoglobin A1c and glucose monitoring from baseline to post tool kit implementation. There was no change in APP confidence scores pre and post tool kit (N = 29).

CONCLUSION

The tool kit designed in this study is an evidence-based resource created by an interdisciplinary team that led to earlier intervention to improve glycemic control in HSCT patients. Due to the complex nature of HSCT patients, a proactive and stepwise approach to managing hyperglycemia is critical to monitoring patients at risk and initiating treatment early to mitigate symptoms.