The Use of an Inpatient Diabetes Order Set Increases the Use of Scheduled Insulin.

Insufficient knowledge of insulin and oral diabetes medications contribute to mismanagement with resulting hyperglycemia in the hospital. To address this, a Diabetes Order Set (DOS) with prescribing guidelines and standardized order forms for insulin and oral diabetes medications was implemented following educational sessions with clinical staff. This Quality Improvement project was a retrospective review comparing diabetes management on two hospital units: one where the order set had been implemented (n=35) and one where it had not (n=35). Glycemic control and appropriateness of diabetes management as assessed by a blinded expert panel was measured in these 70 consecutive medical/surgical patients having 3 days of capillary blood glucose data (CBG) and orders for diabetes medication. Satisfaction by physicians and non-physician practitioners (n=23); nurses (n=24); and clerical staff (n=5) was measured by questionnaire. Basal/bolus insulin was prescribed more frequently (48% vs 11%, p=<.001) on the DOS unit while appropriateness of diabetes management was similar on the 2 units (91% vs 80%, p =.137). Inappropriate management was most often related to inadequate dosing adjustments for hyperglycemia (10/30, 33%) and inappropriate use of sliding scale insulin (6/30, 20%). A similar number of patients experienced mild hypoglycemia (40-69 mg/dl) on both units and there were no episodes of severe hypoglycemia (<40 mg/dl). Corticosteroid therapy was more frequent on the DOS unit (46% vs. 17%, p = .01). After adjusting for corticosteroid use, no difference (p=0.127) was found in the frequency of CBG >250 mg/dl on the DOS unit vs. the control unit (10/19, 53% vs. 8/29, 28%). The surveyed clinicians and staff liked the DOS (81%) and felt it improved patient care (88%). A DOS with prescribing guidelines is associated with more frequent use of scheduled insulin without an increase in hypoglycemia or hyperglycemia. The high degree of acceptance by hospital personnel can be attributed to multidisciplinary support and education that accompanied the implementation. [ABSTRACT FROM AUTHOR]