title: Introduction of New South Wales adult subcutaneous insulin-prescribing chart in a tertiary hospital: its impact on inpatient glycaemic control.
abstract: BACKGROUND
  Erratic blood glucose levels (BGL) are commonly observed amongst patients with diabetes mellitus during hospital admission. Patients on insulin therapy often do not have their doses titrated adequately by their team doctors during admission, and insulin is well known to be a high-risk medication prone to administration error.
  
  
  OBJECTIVE
  To assess the impact of a state-wide adult subcutaneous insulin-prescribing chart (ASCIPC) on glycaemic control and insulin-prescribing pattern in a tertiary hospital.
  
  
  METHODS
  An audit on the clinical records of inpatients who were on subcutaneous insulin therapy in the first week of July 2014 (prior to ASCIPC, n = 56) and in the first week of July 2015 (10 months after introducing ASCIPC, n = 62) was conducted at Liverpool Hospital.
  
  
  RESULTS
  Following the introduction of ASCIPC, fewer BGL readings were missed (9.1 vs 11.6%, P = 0.032), and medical officers were more likely to adjust insulin dosage (71.0 vs 42.6%, P = 0.002) when compared to baseline. Glycaemic control improved, with lower mean BGL (9.4 ± 2.0 vs 10.4 ± 2.6 mmol/L, P = 0.021) and a greater proportion of BGL within the normal range of 5-10 mmol/L (56.2 vs 47.7%, P = 0.041). Omission of insulin doses after ASCIPC remained common, with over 40% of patients having at least one dose of insulin omitted during the audit week.
  
  
  CONCLUSIONS
  Our study showed that the introduction of ASCIPC had positive impacts on glycaemic management for patients on subcutaneous insulin therapy during admission. More work is required to reduce the rate of insulin omission and to improve further glycaemic control for inpatients.
authors.affiliation: Liverpool Diabetes Collaborative Research Unit, Ingham Institute for Applied Medical Research, SWS Clinical School, Sydney, New South Wales, Australia. vincent.wong@sswahs.nsw.gov.au.|Diabetes and Endocrine Service, Liverpool Hospital, Sydney, New South Wales, Australia. vincent.wong@sswahs.nsw.gov.au.
authors.forename: V W
authors.initials: VW
authors.lastname: Wong
authors.affiliation: South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Ho
authors.affiliation: Pharmacy Department, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Fiakos
authors.affiliation: Liverpool Diabetes Collaborative Research Unit, Ingham Institute for Applied Medical Research, SWS Clinical School, Sydney, New South Wales, Australia.|Diabetes and Endocrine Service, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: N S
authors.initials: NS
authors.lastname: Lau
authors.affiliation: Diabetes and Endocrine Service, Liverpool Hospital, Sydney, New South Wales, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Russell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010343:Patient Admission; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diabetes mellitus; hyperglycaemia; inpatient; insulin therapy