Effects of an educational program and a standardized insulin order form on glycemic outcomes in non‐critically ill hospitalized patients

Wesorick, David H.; Grunawalt, Julie; Kuhn, Latoya; Rogers, Mary A.M.; Gianchandani, Roma

doi:10.1002/jhm.780

Cited by 18 publications

(27 citation statements)

References 20 publications

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“…Glycaemic control for hospitalized patients is multifactorial: patients may not comply with diet orders, monitoring or treatment. Successful interventions incorporated education with the introduction of a multi-specialty targeted glycaemic management [18], routine rounds on hyperglycaemic patients with an attending endocrinologist [19], improvements with computerized order entry systems [20], introduction of insulin order sets [21] and insulin order forms [22]. While our data confirm previous findings when training residents, they are limited by the number of analysed patient visits and singlecentre study design.…”

Section: Discussionsupporting

confidence: 79%

Effect of online diabetes training for hospitalists on inpatient glycaemia

et al. 2013

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Section: Discussionsupporting

confidence: 79%

Effect of online diabetes training for hospitalists on inpatient glycaemia

et al. 2013

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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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“…The types of intervention varied, as well as the implementation strategies, and measures of improvement between studies (see Table S4). Although three studies [19] x Courtenay 2007 [17] x x Donihi 2006 [26] x x Dooley 2011 [28] x Donsa 2016 [27] x x Doyle 2014 [54] x x x x Ena 2009 [41] x x Gomez-Huelgas 2014 [55] x x Guerra 2010 [43] x x x Hamilton 2013 [18] x Harbin 2015 [36] x x Helmle 2017 [37] x x x x x x x Horton 2015 [44] x Kowiatek 2001 [29] x x x x Lehnbom 2009 [35] x x Mamillapalli 2012 [38] x Maynard 2009 [45] x x x McIver 2009 [30] x x x Mulla 2015 [39] x x x Newsom 2018 [15] x x x x Noschese 2008m [46] x x Rushmer 2008 [31] x x x Schnipper 2009 [47] x x x Schnipper 2010 [48] x Taylor 2012 [32] x Thompson 2009 [49] x x x Trujillo 2008 [50] x x Tully 2018 [33] x x x Vaidya 2012 [56] x Valgardson 2015 [52] x x Wesorick 2010 [34] x x Wexler 2010 [52] x Wong 2016 [40] x x Yeung 2018 [53] x x ª 2019 Diabetes UK used the UK's National Inpatient Diabetes Audit (NaDIA) methodology and data collection tool, the follow-up period, interventions, implementation and the data reported were varied, hence it was difficult to pool data or make meaningful comparisons [18,19,32]. The introduction of simple, small focused interventions led to an improvement in the completeness and accuracy of insulin prescribing, particularly when they involved 'hard stops' (such as pre-printi...…”

Section: Interventions To Improve Insulin Prescribing Accuracy and Comentioning

confidence: 99%

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

2019

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Aim To conduct a systematic review of literature to identify interventions that are effective in improving insulin prescribing for people with diabetes in the hospital setting. Methods Computerized bibliographic databases were searched for studies published in English that described the effectiveness of interventions to improve insulin prescribing within the hospital setting. Studies were eligible for inclusion if they reported data that compared insulin prescribing practice after an intervention or compared with a control group. Studies were not excluded on the basis of publication date, geographical location or risk of bias assessment. Results We identified 35 studies for inclusion in the review, including two cluster randomized controlled trials, two cohort studies, and 31 uncontrolled before–after studies. Studies reported a variety of interventions that aimed to increase insulin prescribing accuracy or completeness or decrease the use of discouraged subcutaneous sliding scale insulin regimens. Differences in definition of insulin prescribing error, terminology and common practice based on geographical location was evident, and quality issues with respect to study design and reporting somewhat limited the interpretation of conclusions. Conclusions Implementing strategies that are sensitive to local context and designed to increase adherence to insulin prescribing guidelines are associated with a reduction in prescribing errors. Future implementation should build on effective approaches including multifaceted interventions involving multiple stakeholders at various institutional levels. Future studies in insulin prescribing errors would benefit from the use of standardized approaches, terminology and outcome measures to enable greater comparison.

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Effects of an educational program and a standardized insulin order form on glycemic outcomes in non‐critically ill hospitalized patients

Abstract: Disclosure: Nothing to report. BACKGROUND:The optimal approach to managing hyperglycemia in noncritically ill hospital patients is unclear. OBJECTIVE: To investigate the effects of targeted quality improvement interventions on insulin prescribing and glycemic

Cited by 18 publications

References 20 publications

Effect of online diabetes training for hospitalists on inpatient glycaemia

Effect of online diabetes training for hospitalists on inpatient glycaemia

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

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

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