Individualization Through Standardization: Electronic Orders for Subcutaneous Insulin in the Hospital

Kennihan, Mary; Zohra, Tatheer; Devi, Radha; Srinivasan, Chitra; Diaz, Josefina; Howard, Bradley S.; Braithwaite, Susan S.

doi:10.4158/ep12107.ra

Cited by 15 publications

(8 citation statements)

References 78 publications

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“…The use of standardized insulin order sets and management algorithms as tools can yield benefits in managing hyperglycemia (55). Embedding order sets in electronic records or in admission bundles can facilitate physicians’ utilization of existing resources.…”

Section: Discussionmentioning

confidence: 99%

Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

2017

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Objective The management of inpatient hyperglycemia and diabetes requires expertise among many healthcare providers. There is limited evidence about how education for healthcare providers can result in optimization of clinical outcomes. The purpose of this critical review of the literature is to examine methods and outcomes related to educational interventions regarding the management of diabetes and dysglycemia in the hospital setting. This report provides recommendations to advance learning, curricular planning, and clinical practice. Methods We conducted a literature search through PubMed Medical for terms related to concepts of glycemic management in the hospital and medical education and training. This search yielded 1,493 articles published between 2003 and 2016. Results The selection process resulted in 16 original articles encompassing 1,123 learners from various disciplines. We categorized findings corresponding to learning outcomes and patient care outcomes. Conclusion Based on the analysis, we propose the following perspectives, leveraging learning and clinical practice that can advance the care of patients with diabetes and/or dysglycemia in the hospital. These include: (1) application of knowledge related to inpatient glycemic management can be improved with active, situated, and participatory interactions of learners in the workplace; (2) instruction about inpatient glycemic management needs to reach a larger population of learners; (3) management of dysglycemia in the hospital may benefit from the integration of clinical decision support strategies; and (4) education should be adopted as a formal component of hospitals’ quality planning, aiming to integrate clinical practice guidelines and to optimize diabetes care in hospitals.

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Section: Discussionmentioning

confidence: 99%

Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

2017

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“…In non-critically ill patients, therapeutic strategies aiming to control hyperglycemia should consider use of regimens with low risk of hypoglycemia. Suggested hospital glycemic protocols [62] , [63] are a welcome development to reduce hyperglycemia in the hospitalized patients, but these insulin regimens may not take into account heterogeneity of the diabetes phenotypes in the hospital wards, which can pose a risk of hypoglycemia if these protocols are universally used. In fact, efficacy and safety of different initial insulin-containing regimens have not been tested in head to head trials so providers are left alone in selecting the best insulin regimen to treat hyperglycemia and, often, they choose the path of least resistance and initiate “sliding scale” insulin as therapy of choice.…”

Section: Discussionmentioning

confidence: 99%

A practical and evidence-based approach to management of inpatient diabetes in non-critically ill patients and special clinical populations

Gosmanov¹

2016

Journal of Clinical & Translational Endocrinology

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“…11 Most of these studies have demonstrated effectiveness in increasing provider knowledge of inpatient glucose management and improving process measures (eg, adherence to clinical practice guidelines regarding the use of basal-bolus insulin therapy) 4 ; on the other hand, results have been mixed regarding the effectiveness of educational interventions on glycemic outcomes. 11 Components of educational interventions that have produced the most favorable clinical outcomes (beyond provider knowledge alone) include (1) greater hands-on experience within the target clinical context (eg, application of knowledge during supervised clinical rounds), 12 (2) provision of relevant clinical information at the point of care (eg, pocketcards with algorithms/guidelines), 13 (3) "active, participatory and situated learning" rather than passive acquisition of information, 11 (4) integration of educational content with electronic clinical decision support tools (eg, order sets), 14,15 and (5) inclusion of continuing medical education in inpatient glycemic management as part of hospital quality planning. 11 A deficiency that has been noted in previous educational interventions is restricting the education to internal medicine physicians or residents in training only because inpatient glycemic management reaches a much broader group of clinicians in the hospital (eg, surgery, advanced practice clinicians).…”

Section: Journal Of Medical Education and Curricular Developmentmentioning

confidence: 99%

Development, Implementation, and Evaluation of a Physician-Targeted Inpatient Glycemic Management Curriculum

Mathioudakis

Bashura

Boyer

et al. 2019

Journal of Medical Education and Curricular Development

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Objective: Diabetes is prevalent among hospitalized patients and there are multiple challenges to attaining glycemic control in the hospital setting. We sought to develop an inpatient glycemic management curriculum with stakeholder input and to evaluate the effectiveness of this educational program on glycemic control in hospitalized patients. Methods: Using the Six-Step Approach of Kern to Curriculum Development for Medical Education, we developed and implemented an educational curriculum for inpatient glycemic management targeted to internal medicine residents and hospitalists. We surveyed physicians (n = 73) and conducted focus group sessions (n = 18 physicians) to solicit input regarding educational deficits and desired format of the educational intervention. Based on feedback from the surveys and focus groups, we developed educational goals and objectives and a case-based curriculum, which was delivered over a 1-year period via in-person teaching sessions by 2 experienced diabetes physicians at 3 hospitals. Rates of hypoglycemia and hyperglycemia were evaluated among at-risk patient days using an interrupted time-series design. Results: We developed a mnemonic-based (SIGNAL) curriculum consisting of 10 modules, which covers key concepts of inpatient glycemic management and provides an approach to daily glycemic management: S = steroids, I = insulin, G = glucose, N = nutritional status, A = added dextrose, and L = labs. Following implementation of the curriculum, there was no difference in the rates of hyperglycemia in insulin-treated patients following the intervention; however, there was an increase in the rates of hypoglycemia defined as blood glucose (BG) ⩽ 70 mg/dL (5.6% vs 3.0%, P < .001) and clinically significant hypoglycemia defined as BG < 54 mg/dL (1.9% vs 0.8%, P = .01). There was poor penetration of the curriculum, with 60%, 20%, and 90% of the learning modules being delivered at the three participating hospitals, respectively. Conclusions: In this pilot study, a physician-targeted educational curriculum was not associated with improved glycemic control. Adapting the intervention to increase penetration and integrating the curriculum into existing clinical decision support tools may improve the effectiveness of the educational program on glycemic outcomes.

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Individualization Through Standardization: Electronic Orders for Subcutaneous Insulin in the Hospital

Cited by 15 publications

References 78 publications

Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

Perspectives on Learning and Clinical Practice Improvement for Diabetes in the Hospital: A Review of Educational Interventions for Providers

A practical and evidence-based approach to management of inpatient diabetes in non-critically ill patients and special clinical populations

Development, Implementation, and Evaluation of a Physician-Targeted Inpatient Glycemic Management Curriculum

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