title: Improving insulin ordering safely: the development of an inpatient glycemic control program.
abstract: This report describes a Glycemic Control Program instituted at an academic regional level-one trauma center. Key interventions included: 1) development of a subcutaneous insulin physician order set, 2) use of a real-time data report to identify patients with out-of-range glucoses, and 3) implementation of a clinical intervention team. Over four years 18,087 patients admitted to non-critical care wards met our criteria as dysglycemic patients. In this population, glycemic control interventions were associated with increased basal and decreased sliding scale insulin ordering. No decrease was observed in the percent of patients experiencing hperglycemia. Hypoglycemia did decline after the interventions (4.3% to 3.6%; p = 0.003). Distinguishing characteristics of this Glycemic Control Program include the use of real-time data to identify patients with out-of-range glucoses and the employment of a single clinician to cover all non-critical care floors.
authors.affiliation: Division of General Internal Medicine, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA. rethomps@u.washington.edu
authors.forename: Rachel
authors.initials: R
authors.lastname: Thompson
authors.forename: Astrid B
authors.initials: AB
authors.lastname: Schreuder
authors.forename: Brent
authors.initials: B
authors.lastname: Wisse
authors.forename: Kenny
authors.initials: K
authors.lastname: Jarman
authors.forename: Kathleen
authors.initials: K
authors.lastname: Givan
authors.forename: Louise
authors.initials: L
authors.lastname: Suhr
authors.forename: Dawn
authors.initials: D
authors.lastname: Corl
authors.forename: Becky
authors.initials: B
authors.lastname: Pierce
authors.forename: Robert
authors.initials: R
authors.lastname: Knopp
authors.forename: J Richard
authors.initials: JR
authors.lastname: Goss
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D008875:Middle Aged; D016134:Organizational Policy; D011785:Quality Assurance, Health Care; D012307:Risk Factors; D012720:Severity of Illness Index; D014193:Trauma Centers; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin