title: Computerized Insulin Order Sets Can Lead to Unanticipated Consequences.
abstract: Computerized order sets for medication management were recently shown to be associated with increased patient safety risks in primary care setting. This study was aimed at demonstrating similar phenomenon in a hospital setting. After introduction of computerized order set targeting hypoglycemia, the frequency of hypoglycemia significantly decreased from 1/1/07 to 12/31/08. However, the frequency of hyperglycemia also increased at the same time from 1/1/07 to 12/31/07. Only after subsequent introduction of a hospital-wide standardized insulin order set including hyperglycemia policies, the frequency of hyperglycemic episodes declined. Hypo/hyperglycemia is associated with adverse clinical outcomes in the inpatient setting. Retroactive analysis showed that if hypoglycemic and hyperglycemic policies were introduced simultaneously, unexpected increase in frequency of hyperglycemic episodes could have been avoided. These data are informative in identifying unanticipated consequences of an insulin management order sets focused entirely on hypoglycemia. A balanced approach in implementing insulin management EMR order sets that concurrently addresses both hypoglycemia and hyperglycemia policies is warranted.
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: McKenzie
authors.initials: M
authors.lastname: Bedra
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Sherita
authors.initials: S
authors.lastname: Hill Golder
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Eunme
authors.initials: E
authors.lastname: Cha
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: In Cheol
authors.initials: IC
authors.lastname: Jeong
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Finkelstein
mesh_terms: D001786:Blood Glucose; D002985:Clinical Protocols; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D050316:Medical Order Entry Systems; D061214:Patient Safety; D057766:Policy; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin