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J Hosp Med. 2009 Jan;4(1):16-27. doi: 10.1002/jhm.385.

Effects of a subcutaneous insulin protocol, clinical education, and computerized order set on the quality of inpatient management of hyperglycemia: results of a clinical trial.

Author information

1
Brigham and Women's/Academic Hospitalist Program, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02120-1613, USA. jschnipper@partners.org

Abstract

BACKGROUND:

Inpatient hyperglycemia is associated with poor patient outcomes. It is unknown how best to implement glycemic management strategies in the non-intensive care unit (ICU) setting.

OBJECTIVE:

To determine the effects of a multifaceted quality improvement intervention on the management of medical inpatients with diabetes mellitus or hyperglycemia.

DESIGN:

Before-after trial.

SETTING:

Geographically localized general medical service staffed by physician's assistants (PAs) and hospitalists.

PATIENTS:

Consecutively enrolled patients with type 2 diabetes or inpatient hyperglycemia.

INTERVENTION:

A detailed subcutaneous insulin protocol, an admission order set built into the hospital's computerized order entry system, and case-based educational workshops and lectures to nurses, physicians, and PAs.

MEASUREMENTS:

Mean percent of glucose readings per patient between 60 and 180 mg/dL; percent patient-days with hypoglycemia; insulin use patterns; and hospital length of stay.

RESULTS:

The mean percent of readings per patient between 60 and 180 mg/dL was 59% prior to the intervention and 65% afterward (adjusted effect size 9.7%; 95% confidence interval [CI], 0.6%-18.8%). The percent of patient days with any hypoglycemia was 5.5% preintervention and 6.1% afterward (adjusted odds ratio 1.1; 95% CI, 0.6-2.1). Use of scheduled nutritional insulin increased from 40% to 75% (odds ratio 4.5; 95% CI, 2.0-9.9) and adjusted length of stay decreased by 25% (95% CI, 9%-44%). Daily insulin adjustment did not improve, nor did glucose control beyond hospital day 3.

CONCLUSIONS:

This multifaceted intervention, which was easy to implement and required minimal resources, was associated with improvements in both insulin ordering practices and glycemic control among non-ICU medical patients.

PMID:
19140191
DOI:
10.1002/jhm.385
[Indexed for MEDLINE]

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