Knowledge Translation to Optimize Adult Inpatient Glycemic Management With Basal Bolus Insulin Therapy and Improve Patient Outcomes

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

“…Only two studies looked at economic or financial sustainability/ impact of interventions [25,33] and there was a general lack of consideration of the theoretical basis or justification for interventions. Well-reported studies included details of usual care in the control/before group, as well as the organizational characteristics and readiness for change [15,29,33,37,46,57].…”

“…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...…”

“…The majority of the studies were conducted in the USA (n=17). Three studies were conducted in Canada [36,37,54], two in Australia [35,57] and two in Spain [41,55].…”

“…Most interventions involved the introduction of insulin order sets using Computerized physician order entry or a dedicated insulin order form, often including decision support tools such as guidelines or dosing algorithms. Eleven studies described the implementation of electronic insulin order sets [15,27,37,42,43,45,47,48,[51][52][53]. More significant improvements were seen when prescribers were required to use insulin order sets to prescribe insulin (i.e.…”

Diabetes, Obesity and Nutrition Strategic Clinical Network

“…An audit of selected hospitals also showed that basal bolus insulin therapy (the current standard of care) was included in only 27% of insu lin orders. 9 DON SCN Core Committee members together with experts in patient engagement and inhospital management of diabetes led several stakeholders in the development of a multi faceted strategy to address these issues (Appendix 2). This in hospital diabetes care initiative built on lessons learned from an earlier failed pilot implementation in a single hospital that used education and an order set as the primary tools to facilitate change but lacked a comprehensive integrated knowledge trans lation strategy to support the change process.…”