Insulin Infusion Computer Calculator Programmed Directly Into Electronic Health Record Medication Administration...

Area of Science:

• Clinical Informatics
• Endocrinology
• Patient Safety

Background:

• Computerized insulin infusion protocols enhance staff satisfaction and patient glucose control compared to paper-based methods.
• University of California San Diego Health (UCSDH) integrated an insulin infusion computer calculator (IICC) into their electronic medication administration record (eMAR) within their primary electronic health record (EHR).

Purpose of the Study:

• To evaluate the safety and effectiveness of an IICC integrated into an eMAR for intravenous insulin infusions.
• To assess the impact of eMAR integration on glucose control and hypoglycemia rates.

Main Methods:

• Retrospective analysis of 6306 adult patients receiving IV insulin infusions from March 2013 to May 2019.
• Comparison of glucose readings within target ranges (90-150 mg/dL for ICU, 90-180 mg/dL for non-ICU) across pre-eMAR integration, eMAR integration, and post-eMAR integration periods.
• Evaluation of safety endpoints, including incidence of blood glucose readings <70 mg/dL, <54 mg/dL, and <40 mg/dL.

Main Results:

• Post-eMAR integration showed a slight but statistically significant improvement in glucose readings within the target range for patients without hyperglycemic emergencies (70.2% vs. 69.8%, P = .03 for 90-150 mg/dL; 82.9% vs. 82.7%, P = .09 for 90-180 mg/dL).
• Hypoglycemia rates remained low across all periods: <70 mg/dL (0.43%), <54 mg/dL (0.07%), and <40 mg/dL (0.01%).

Conclusions:

• The integrated IICC is a safe and effective tool for managing intravenous insulin infusions in diverse clinical settings.
• Successful transition of the IICC from a standalone platform to the primary EHR's eMAR was achieved.