SUN-166 Insulin Dose Calculator in a Pediatric Hospital

Abstract

Background: To decrease delays in inpatient insulin ordering and administration, our children’s hospital implemented an insulin-dose-calculator (IDC) imbedded in the electronic health record. A multidisciplinary team developed the IDC, modeling it after a similar tool in place at another children’s hospital. 1 This calculator provides an innovative approach to the complex and time-consuming process of dosing, ordering, and administering rapid-acting insulin in the inpatient setting. Prior to implementation of the IDC, rapid acting insulin dosing, ordering, and administration required 7-steps with 6 identified areas of delay. The IDC streamlined this into a 4-step process, eliminating 5 out of 6 areas of delay. Here, we describe the benefits of an insulin dose calculator in terms of efficiency, safety, and overall streamlining of inpatient care of insulin-dependent diabetic patients. Methods: This pre- and post- implementation cohort study measured delays between (1) point-of-care (POC) glucose testing and insulin ordering and (2) between POC glucose testing and insulin administration. The pre-implementation cohort included pediatric patients receiving insulin admitted to our hospital between 2011 and 2017 (n=644). Those who received insulin via the IDC will be included in the post-implementation cohort. Pre- and post-implementation delays were compared to determine the impact of the tool on patient care and hospital efficiency. Additionally, pre- and post-implementations surveys were completed by the pediatric nursing staff to capture data on nursing and patient satisfaction. Finally, insulin-related safety events were collected pre-and post-implementation. Results: Prior to implementation of the IDC, the average delay between POC glucose testing and insulin ordering was 22 minutes. The average delay between POC glucose testing and insulin administration was 37 minutes. Preliminary data at the time of this abstract submission supports a decrease in the delay between POC glucose testing and insulin administration after implementation of the IDC tool. Results from the pre-implementation nursing survey revealed that 75% of nurses were dissatisfied with the previous process and that they perceived most patients were dissatisfied as well. Conclusion: Implementation of an IDC tool will minimize delays in ordering and administering of rapid-acting insulin, as well as increase nursing satisfaction, while maintaining a safe system for insulin dosing. 1. Aiyagari R, Moran C, Singer K, Ateya M. Insulin Bolus Calculator in a Pediatric Hospital.  Applied Clinical Informatics . 2017;08(02):529-540. doi:10.4338/aci-2016-11-ra-0187.