Indication‐Based Ordering: A New Paradigm for Glycemic Control in Hospitalized Patients

1Division of Hospital Medicine and Department of Information Services, UCSD Medical Center, San Diego, CA
2Division of Hospital Medicine and Department of Information Services, UCSD Medical Center, San Diego, CA
3Department of Information Services, UCSD Medical Center, San Diego, CA
4Division of Hospital Medicine, UCSD Medical Center, San Diego, CA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 95

Background:

Improving inpatient glycemic control is challenging. Institutional insulin management protocols and structured order sets are commonly advocated but are not well studied as methods to improve glycemic control. Integration of protocol guidance into the insulin ordering process is needed.

Purpose:

To describe the development of a computerized provider order entry (CPOE) order set for subcutaneous insulin wherein providers are actively guided to follow an insulin management protocol.

Description:

A basic CPOE insulin order set was first introduced, allowing providers to order basal, nutritional, and correctional‐scale insulin within the same order set. A best‐practice paper insulin management protocol was then introduced as part of a small‐scale quality improvement project on the general medicine service. Using pharmacy data and point‐of‐care glucose tests, insulin use patterns, glycemic control rates, and hypoglycemia rates were tracked. When improvements in these metrics were seen, the principles of the paper protocol were then built into an updated version of the CPOE insulin order set, which used provider‐entered parameters of weight, insulin resistance, and dietary pattern as indications to prompt the provider to order the appropriate basal, nutritional, and correctional insulin. This improved both the flexibility and ease of use of the order set. With the introduction of the paper protocol, basal insulin use increased, and the percentage of patient‐days with hypoglycemia decreased from 3.7% to 2.6% (RR 0.70, CI 0.62‐0.80). The relative risk of an inpatient stay with a mean glucose greater than 180 was 0.84 (CI 0.77‐0.91) with the initial CPOE order set and decreased further to 0.73 (CI 0.66‐0.81) with the paper protocol. These improvements have been sustained with the incorporation of the protocol into the new CPOE order set.

Conclusions:

Patient parameter and protocol‐based clinical decision support added to CPOE can improve glycemic control. Using indication‐based ordering with CPOE is a viable strategy to improve inpatient glycemic control.

Author Disclosure:

B. Clay, none; J. Lee, none; Z. Zelazny, none; G. Maynard, none.

To cite this abstract:

Clay B, Lee J, Zelazny Z, Maynard G. Indication‐Based Ordering: A New Paradigm for Glycemic Control in Hospitalized Patients. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 95. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/indicationbased-ordering-a-new-paradigm-for-glycemic-control-in-hospitalized-patients/. Accessed November 18, 2019.

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