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Computerized Insulin Order Sets Can Lead to Unanticipated Consequences.

McKenzie Bedra1, Sherita Hill Golder1, Eunme Cha1

  • 1Johns Hopkins University, Baltimore, MD, USA.

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Computerized order sets for hypoglycemia management in hospitals reduced low blood sugar but increased high blood sugar. Simultaneous policies for both conditions are recommended for patient safety.

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Area of Science:

  • Medical Informatics
  • Patient Safety
  • Endocrinology

Background:

  • Computerized order sets are increasingly used for medication management.
  • Previous studies indicated potential patient safety risks with these systems in primary care.
  • The impact of order sets targeting specific glycemic conditions in hospitals remains under-evaluated.

Purpose of the Study:

  • To evaluate the impact of a computerized order set targeting hypoglycemia on glycemic control in a hospital setting.
  • To assess the simultaneous effects on hyperglycemia frequency.
  • To determine the necessity of a balanced approach in electronic medication record (EMR) order set implementation.

Main Methods:

  • Retrospective analysis of patient data before and after implementation of a hypoglycemia-focused order set.
  • Comparison of hypoglycemia and hyperglycemia episode frequencies.
  • Evaluation of outcomes following the introduction of a standardized insulin order set addressing both hypo/hyperglycemia.

Main Results:

  • Introduction of a hypoglycemia-focused order set significantly decreased hypoglycemia frequency.
  • Concurrently, hyperglycemia frequency increased.
  • Subsequent implementation of a comprehensive insulin order set addressing both hypo/hyperglycemia led to a decline in hyperglycemic episodes.

Conclusions:

  • Insulin management order sets focused solely on hypoglycemia can lead to unintended increases in hyperglycemia.
  • Simultaneous implementation of policies for both hypoglycemia and hyperglycemia is crucial.
  • A balanced approach in EMR order set design is warranted to optimize patient safety and glycemic control.