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Decreased rates of hypoglycemia following implementation of a comprehensive computerized insulin order set and

Naina Sinha Gregory1, Jane Jeffrie Seley1, Linda M Gerber1

  • 1a Joan and Sanford I Weill Medical College of Cornell University , Endocrinology , New York , NY , USA.

Hospital Practice (1995)
|November 3, 2016
PubMed

Insights

Implementing a computerized insulin order set and titration algorithm reduced hypoglycemia in hospitalized patients. While effective in lowering low blood sugar, this intervention also led to increased hyperglycemia rates.

Area of Science:

  • Inpatient glycemic control
  • Medical informatics
  • Clinical quality improvement

Background:

  • Hospital hyperglycemia affects over one-third of patients.
  • Improved glycemic control is linked to better patient outcomes.
  • Achieving target glycemic levels in hospitals remains a significant challenge.

Purpose of the Study:

  • To assess the impact of a computerized insulin order set and titration algorithm.
  • To evaluate effects on inpatient hypoglycemia and overall glycemic control.

Main Methods:

  • A prospective observational study in an academic medical center.
  • Involved hospital-wide implementation of an insulin order set.
  • Added an insulin titration algorithm in pilot units, analyzing blood glucose data.

Main Results:

  • The insulin order set decreased hypoglycemia (1.92% to 1.61%) but increased hyperglycemia (24.02% to 27.27%).
  • The addition of the titration algorithm further reduced hypoglycemia (2.57% to 1.82%) and increased hyperglycemia (31.76% to 41.33%).

Conclusions:

  • A computerized insulin order set and algorithm effectively reduced hypoglycemia.
  • The reduction in hypoglycemia was accompanied by an increase in hyperglycemia.
  • Integrating the algorithm into the electronic medical record could improve adoption and adherence.
Abstract

Keywords:
Hypoglycemiacomputerized order setshyperglycemiainpatient glycemic control

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