Barriers to Implementing an Insulin Order Form In a Non-ICU Medical Unit

We sought to evaluate barriers to the implementation of a standardized subcutaneous (SQ) insulin order form in a non-ICU medical unit.

An insulin task force comprising physicians, nurses, dietitians, and pharmacists developed and implemented an SQ insulin order form in a community-based teaching hospital. A prospective observational study was conducted to identify difficulties in adopting the form and to delineate requirements for staff education. The main outcome measure was utilization of the form.

The development of a standardized SQ insulin order set for the medical inpatient unit was intended to include a more physiological approach to the control of hyperglycemia. During an eight-week pilot period, only 9% of physician orders included basal, bolus, and correctional-dose (BBC) components of the order form. Because of a limited patient size and low utilization of the order form, it is difficult to determine whether use of the form succeeded in decreasing the occurrence of hyperglycemia. Experience gained from the initial implementation indicates that teaching personnel how to use the form and how to combine long-acting and short-acting insulins to prevent or control hyperglycemia are necessary for the form to gain acceptance.

The extent to which the medical staff used the SQ insulin order form was modest. Clinician acceptance and education about hyperglycemia early on are essential for the successful adoption of a standardized tool into clinical practice.