Improving insulin ordering safely: The development of an inpatient glycemic control program

Abstract

This report describes a Glycemic Control Program instituted at an academic regional level-one trauma center. Key interventions included: 1) development of a subcutaneous insulin physician order set, 2) use of a real-time data report to identify patients with out-of-range glucoses, and 3) implementation of a clinical intervention team. Over four years 18,087 patients admitted to non-critical care wards met our criteria as dysglycemic patients. In this population, glycemic control interventions were associated with increased basal and decreased sliding scale insulin ordering. No decrease was observed in the percent of patients experiencing hperglycemia. Hypoglycemia did decline after the interventions (4.3% to 3.6%; p = 0.003). Distinguishing characteristics of this Glycemic Control Program include the use of real-time data to identify patients with out-of-range glucoses and the employment of a single clinician to cover all non-critical care floors.

Clinical decision support systems in the care of inpatients with diabetes in non‐critical care setting: systematic review

“…Eleven studies met the inclusion criteria for our review [21][22][23][24][25][26][27][28][29][30][31]. After excluding duplicates, we screened titles and abstracts of 1110 articles.…”

“…Full texts of 62 articles meeting the criteria or of uncertain nature were obtained. Eleven studies met the inclusion criteria for our review [21][22][23][24][25][26][27][28][29][30][31]. Another three articles meeting the inclusion criteria were identified through the secondary search [32][33][34] (Fig.…”

“…Two of the studies were cluster randomized controlled trials [23,32]. Another eight studies had before-and-after analysis [22,24,27,28,30,31,33,34]; however, only one of them was a planned interventional study [24] and another a prospective analysis of observational data [34], while all others were retrospective analysis of observational data. Of the remaining studies, one was a case series [25] and the other three were observational descriptive studies [21,26,29].…”

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes

“…The majority of studies evaluating this intervention showed positive results, with reductions in both hypoglycemia and hyperglycemia rates [111, 120–122]. One study showed no significant improvements in glycemic control with the use of a “multi-component intervention that included an out-of-range glucose report derived electronically” [123]. The financial impact of glucose dashboards for health systems has not been formally studied.…”

Unintended Consequences of a Standard Admission Order Set on Venous Thromboembolism Prophylaxis and Patient Outcomes

“…Order sets have successfully increased the provision of underused interventions such as venous thromboembolism pharmacoprophylaxis (VTEP), 1,2 basal insulin therapy, 3,4 and aggressive fluid resuscitation for sepsis; 5,6 many of these have been modularized and merged into comprehensive order sets 1 in the context of quality improvement initiatives. Quality improvement initiatives have the potential for unintended consequences.…”