Implementation of a Standardized Admission Hyperglycemia Insulin Order Set in a Veterans Hospital

 

Abstract

Purpose: The efficacy of an implemented hyperglycemia admission insulin order set containing basal-bolus-correction regimens to facilitate protocol-adherent prescribing in non-critically ill patients was evaluated.

Method: In this retrospective, single-center, observational study, patients age 18 years or older with a history of type 2 diabetes or admission blood glucose >180mg/dL were identified through electronic medical record review of patients admitted to medicine wards. Patients were excluded if admitted to intensive care or surgical units during hospitalization, identified to have a history of type I diabetes, treated for diabetic ketoacidosis, pregnant, or allergic to insulin. Patients were evaluated pre- and post-protocol implementation. The primary endpoint was mean hospitalization glucose levels. Secondary endpoints included: percentage of patients with average hospitalization glucose < 180mg/dL, percentage of basal insulin utilization, and hypoglycemia incidence.

Results: A total of 200 patients were included in this study, with 100 patients in each group. Average hospitalization glucose was not significantly lower in the post-implementation group compared to the pre-implementation group (169 vs. 177mg/dL, p=0.33). More patients in the post-implementation group had mean hospitalization glucose < 180mg/dL, though this was not significant (66 vs. 55%, p=0.15). However, percentage of patients with basal insulin use did not change (43% vs 44%, p=1.00). There was no difference in hypoglycemic episodes (27 vs 24 events, p=0.75).

Conclusion: The new basal-bolus-correction insulin order set at STVHCS is not associated with any difference in inpatient hyperglycemia control. Education at multiple interdisciplinary levels is required for effective hyperglycemia protocol implementation.

Read More about this Article: https://juniperpublishers.com/jojcs/JOJCS.MS.ID.555701.php

Read More Juniper Publishers Google Scholar:  https://scholar.google.com/citations?view_op=view_citation&hl=en&user=rp_7-igAAAAJ&citation_for_view=rp_7-igAAAAJ:BrmTIyaxlBUC