Improving Insulin Administration Through Redesigning Processes of Care: A Multidisciplinary Team Approach

Citty, Sandra Wolfe; Zumberg, Lisa; Chappell, Justina

doi:10.1097/pts.0000000000000128

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Use of electronic medication management (EMM) software systems reduce medicine error rates but training of staff to use systems is paramount, especially as EMM systems impact on work ow (7). While electronic prescribing provides signi cant bene ts over handwritten medication charts it has been shown to contribute to new types of errors compared with paper charts (6,8).…”

Section: Introductionmentioning

confidence: 99%

Analysis of pharmacist interventions associated with insulin prescribing for hospital inpatients with diabetes

Zipf

Grant

Robinson

et al. 2021

Preprint

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Background: Insulin is a high-risk medicine, associated with hospital medication errors. Pharmacists play an important role in the monitoring of patients on insulin. Objective: To analyse interventions made by hospital pharmacists that were associated with insulin prescribing for inpatients with diabetes.Method: Retrospective audit of pharmacist interventions for adult inpatients for an 8-month period, 1 June 2019 to 31 January 2020. Pharmacist interventions recorded in the electronic medication management system by inpatient unit and dedicated high-risk medicine pharmacists were extracted, screened, and analysed.Results: Of 3,975 pharmacist interventions 3,356 (84.43%) were recorded by high-risk medicine pharmacists and 619 (15.57%) by inpatient unit pharmacists. July and August 2019 had the highest numbers of interventions with 628 and 643 (15.80% and 16.18%) respectively. Most of the interventions, namely 3,410 (85.79%) were classified as medicine optimisation interventions and 565 (14.21%) as prescribing errors. In the medicine optimisation intervention category, 2,985 (75.09%) were due to insulin not charted for ongoing administration.Conclusion: This study provides insights into pharmacist interventions for inpatients on insulin, showing that high-risk medicine pharmacists recorded most interventions. The classification of the insulin interventions into medicine optimisation and prescribing errors provides useful information for the training of prescribers in insulin management.

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Section: Introductionmentioning

confidence: 99%

Analysis of pharmacist interventions associated with insulin prescribing for hospital inpatients with diabetes

Zipf

Grant

Robinson

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…These include use of computerized order entry to decrease medication errors [16][17][18][19] and standardized "order sets" to reduce mistakes of omission. [20][21][22][23] Clinical decision support services (CDSSs) have been proposed and studied as a more generalized check against errors in patient care. [24][25][26] By contrast, technological innovation designed to support safe, independent clinical decision-making by trainees adapting to new practice environments has not been previously reported.…”

Section: Introductionmentioning

confidence: 99%

Orientation in Perpetuity: An Online Clinical Decision Support System for Surgical Residents

Papandria

Fisher

Kenney

et al. 2020

Journal of Surgical Research

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“…11 Similarly, a quality improvement study reported a process improvement project that improved the rate of errors of omission of insulin by 54% by adding scheduled standardized order sets, extensive nursing staff education, and enhanced efficiency of the existing process. 29 Because of the positive findings of both of these studies, our team decided to redesign our current process and add nutritional supplements to the medication order sets in the electronic health record and medication administration record (eMAR). Further, we created a tab within the EMAR that was focused on nutritional medications.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the electronic health record to standardize administration and documentation of nutritional supplements

Citty

Kamel

Garvan

et al. 2017

BMJ Qual Improv Report

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Malnutrition in hospitalized patients is a major cause for hospital re-admission, pressure ulcers and increased hospital costs. Methods to improve the administration and documentation of nutritional supplements for hospitalized patients are needed to improve patient care, outcomes and resource utilization. Staff at a medium-sized academic health science center hospital in the southeastern United States noted that nutritional supplements ordered for patients at high risk for malnutrition were not offered or administered to patients in a standardized manner and/or not documented clearly in the electronic health record as per prescription. This paper reports on a process improvement project that redesigned the ordering, administration and documentation process of oral nutritional supplements in the electronic health record. By adding nutritional products to the medication order sets and adding an electronic nutrition administration record (ENAR) tab, the multidisciplinary team sought to standardize nutritional supplement ordering, documentation and administration at prescribed intervals. This process improvement project used a triangulated approach to evaluating pre- and post-process change including: medical record reviews, patient interviews, and nutrition formula room log reports. Staff education and training was carried out prior to initiation of the system changes. This process change resulted in an average decrease in the return of unused nutritional formula from 76% returned at baseline to 54% post-process change. The process change resulted in 100% of nutritional supplement orders having documentation about nutritional medication administration and/or reason for non-administration. Documentation in the ENAR showed that 41% of ONS orders were given and 59% were not given. Significantly more patients reported being offered the ONS product (p=0.0001) after process redesign and more patients (5% before ENAR and 86% after ENAR reported being offered the correct type, amount and frequency of nutritional products (p=0.0001). ENAR represented an effective strategy to improve administration and documentation of nutritional supplements for hospitalized patients.

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Improving Insulin Administration Through Redesigning Processes of Care: A Multidisciplinary Team Approach

Cited by 5 publications

References 12 publications

Analysis of pharmacist interventions associated with insulin prescribing for hospital inpatients with diabetes

Analysis of pharmacist interventions associated with insulin prescribing for hospital inpatients with diabetes

Orientation in Perpetuity: An Online Clinical Decision Support System for Surgical Residents

Optimizing the electronic health record to standardize administration and documentation of nutritional supplements

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