Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin.
OBJECTIVE
Sliding scale insulin (SSI) is frequently used for inpatient management of hyperglycemia and is associated with a large number of medication errors and adverse events including hypoglycemia and hyperglycemia.


METHODS
Observational before and after study evaluating the impact of implementation of a standardized SSI protocol and preprinted physician order form.


METHODS
University Hospital in Pittsburgh, PA, USA.


METHODS
Guidelines for the use of SSI were created by an interdisciplinary committee and implemented in non-intensive care units. In addition, a preprinted physician order sheet was developed which included the guidelines and an option for ordering one of three standardized insulin sliding scales or a patient specific scale. EFFECT OF CHANGE: One year after implementation the physician order form was used for 91% of orders and, overall, 86% of SSI orders followed the guidelines. The number of prescribing errors found on chart review was reduced from 10.3 per 100 SSI patient-days at baseline to 1.2 at 1 year (p = 0.03). The number of hyperglycemia episodes 1 year after implementation decreased from 55.9 to 16.3 per 100 SSI patient-days.


CONCLUSIONS
The protocol was readily accepted by hospital staff and was associated with decreased prescribing errors and decreased frequency of hyperglycemia.
University of Pittsburgh, 302 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USA. calabresea@upmc.edu
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Donihi
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DiNardo
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DeVita
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Korytkowski
D001786:Blood Glucose / Q000032:analysis; D002985:Clinical Protocols; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D019983:Guideline Adherence; D006757:Hospital Units / Q000592:standards; D006785:Hospitals, University / Q000592:standards; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology; D007003:Hypoglycemia / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D010414:Pennsylvania; D017410:Practice Guidelines as Topic
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin