title: Tides of change: improving glucometrics in a large multihospital health care system.
abstract: BACKGROUND
  This study explores the relationship between education for inpatient diabetes providers and the utilization of insulin order sets, inpatient glucometrics, and length of stay in a large health care system.
  
  
  METHODS
  The study included patients with and without the diagnosis of diabetes. An education campaign included provider-directed diabetes education administered via online learning modules and in-person presentations by trained individuals. Relationships among provider-attended diabetes education, order set usage, and inpatient glucometrics (hypo- and hyperglycemia) were analyzed, as well as length of stay.
  
  
  RESULTS
  Insulin use knowledge scores for all providers averaged 52%, and improved significantly to 93% (P < .001) by the end of the education intervention period. Likewise utilization of electronic basal-bolus order sets increased from a baseline of 20% for patients receiving insulin to 86% within 6 weeks (P < .01) of introduction of order sets. During the study, the incidence of hypoglycemia and hyperglycemia declined from 1.47% to 1.27% and from 23.21% to 17.80%, respectively. However, these improvements were not sustained beyond the completion of the education campaign.
  
  
  CONCLUSIONS
  Education of diabetes health care providers was provided in a large, multihospital system through the use of online learning modules. Adoption of standardized insulin order sets was associated with an improvement in glucometrics. This educational and quality initiative resulted in overall improvements in insulin knowledge, adherence to recommended order sets, inpatient glucometrics, and patient length of stay. These improvements were not sustained, reinforcing the need for repeated educational interventions for those involved in providing inpatient diabetes care.
authors.affiliation: Eastern Virginia Medical School, Department of Medicine, Norfolk, VA, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Mulla
authors.affiliation: Eastern Virginia Medical School, Department of Medicine, Strelitz Diabetes Center for Endocrine and Metabolic Disorders, Norfolk, VA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Lieb
authors.affiliation: Glytec Systems, Greenville, SC, USA.
authors.forename: Raymie
authors.initials: R
authors.lastname: McFarland
authors.affiliation: Eastern Virginia Medical School, Department of Medicine, Strelitz Diabetes Center for Endocrine and Metabolic Disorders, Norfolk, VA, USA aloija@evms.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Aloi
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D003695:Delivery of Health Care / Q000639:trends*; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy*; D020375:Education, Distance; D006282:Health Personnel / Q000193:education*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D020407:Internet; D009726:Nurses; D010595:Pharmacists; D010820:Physicians; D058996:Quality Improvement
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diabetes; glucometrics; hospital; inpatient; quality improvement