Effects of a Computerized Order Set on the Inpatient Management of Hyperglycemia: A Cluster-Randomized Controlled Trial

Schnipper, Jeffrey L.; Liang, Catherine; Ndumele, Chima D.; Pendergrass, Merri

doi:10.4158/ep09262.or

Cited by 77 publications

(93 citation statements)

References 23 publications

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“…23 Studies by others have shown that a combination of structured insulin orders combined with staff education to partially alleviates clinical inertia in the hospital. [24][25][26][27][28][29] Our facility implemented computerized order entry in 2007 that includes provisions to order basal, prandial, and correction insulin treatment that are accessible to all practitioners. However, despite all these efforts at our institution, clinical inertia remains evident among the inpatient surgical practices.…”

Section: Discussionmentioning

confidence: 99%

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Coan

Schlinkert

Beck

et al. 2013

J Diabetes Sci Technol

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Objective:Our objective was to assess the application of insulin regimens in surgical postoperative patients with diabetes. Methods:A chart review was conducted of patients with diabetes who were hospitalized postoperatively between January 1 and April 30, 2011. Analysis was restricted to patients hospitalized for ≥3 days and excluded cases with an endocrinology consult. Insulin regimens were categorized as "basal plus short acting," "short acting only," or "none," and the pattern of use was evaluated by hyperglycemia severity according to tertiles of both mean glucose and the number of glucose measurements >180 mg/dl. Results:Among cases selected for analysis (n = 119), examination of changes in insulin use based on tertiles of mean glucose showed that use of basal plus short-acting insulin increased from 10% in the lowest tertile (mean glucose, 120 mg/dl) to 18% in the highest tertile (mean glucose, 198 mg/dl; p < .01); however, 70% of patients in the highest tertile continued to receive short-acting insulin only, with 12% receiving no insulin. Intensification of insulin to a basal plus short-acting regimen was also seen when changes were evaluated by the number of measurements >180 mg/dl (p < .01), but 70% and 12% of patients in the highest tertile still remained only on short-acting insulin or received no insulin, respectively. Conclusions:Use of basal plus short-acting insulin therapy increased with worsening hyperglycemia, but many cases did not have therapy intensified to the recommended insulin regimen-evidence of clinical inertia. Strategies should be devised to overcome inpatient clinical inertia in the treatment of postoperative patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Coan

Schlinkert

Beck

et al. 2013

J Diabetes Sci Technol

View full text Add to dashboard Cite

show abstract

“…We had done this to ensure that providers only used our insulin order sets, in contrast to what has been done in some other institutions where the use of these order sets was optional. 13 From experience, we did not want to allow for "rogue" insulin orders that could lead to misinterpretation, errors, duplicates, and orders placed without hypoglycemia protocol orders and other linked orders. So, for example, if a provider typed in "lispro" in the medication order field, he or she would not find anything.…”

Section: Step 4: Optimizationmentioning

confidence: 99%

A Detailed Description of the Implementation of Inpatient Insulin Orders With a Commercial Electronic Health Record System

Neinstein

MacMaster

Sullivan

et al. 2014

J Diabetes Sci Technol

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Background: In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Process:Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process.Conclusions: Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation.

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“…Standardized orders for scheduled and correction-dose insulin should be implemented, while sole reliance on an SSI regimen is strongly discouraged. As hospitals move to comply with "meaningful use" regulations for electronic health records, as mandated by the Health Information Technology for Economic and Clinical Health Act, efforts should be made to ensure that all components of structured insulin order sets are incorporated into electronic insulin order sets (23,24).…”

Section: Diabetes Care Providers In the Hospitalmentioning

confidence: 99%

13. Diabetes Care in the Hospital, Nursing Home, and Skilled Nursing Facility

2014

Diabetes Care

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Effects of a Computerized Order Set on the Inpatient Management of Hyperglycemia: A Cluster-Randomized Controlled Trial

Cited by 77 publications

References 23 publications

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

Clinical Inertia during Postoperative Management of Diabetes Mellitus: Relationship between Hyperglycemia and Insulin Therapy Intensification

A Detailed Description of the Implementation of Inpatient Insulin Orders With a Commercial Electronic Health Record System

13. Diabetes Care in the Hospital, Nursing Home, and Skilled Nursing Facility

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