title: Using standardized insulin orders to improve patient safety in a tertiary care centre.
abstract: OBJECTIVE
  To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety.
  
  
  METHODS
  Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control.
  
  
  RESULTS
  Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation.
  
  
  CONCLUSIONS
  The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre.
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada.
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Doyle
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Brez
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada.
authors.forename: Silvana
authors.initials: S
authors.lastname: Sicoli
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada.
authors.forename: Filomena
authors.initials: F
authors.lastname: De Sousa
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Keely
authors.affiliation: Division of Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada. Electronic address: jamalcolm@TOH.on.ca.
authors.forename: Janine C
authors.initials: JC
authors.lastname: Malcom
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002170:Canada; D020000:Decision Support Systems, Clinical; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index; D019983:Guideline Adherence; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use*; D033183:Interdisciplinary Communication; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D061214:Patient Safety; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D062606:Tertiary Care Centers
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: aide à la décision clinique; amélioration de la qualité; decision support clinical; diabetes; diabète; méthodologie de l’amélioration de la qualité; patient safety; quality improvement; quality improvement methodology; sécurité des patients