Implementation of a Multihospital Electronic Medical Record-Based Insulin Order Set to Reduce Hypoglycemic Events

Area of Science:

• Internal Medicine
• Endocrinology
• Quality Improvement

Background:

• Glycemic control in hospitalized patients with diabetes is challenging and hypoglycemia increases risks.
• Standardized insulin order sets can improve glycemic management and reduce adverse events.

Purpose of the Study:

• To evaluate the impact of a mandatory electronic medical record-based insulin order set on hypoglycemia and hyperglycemia in hospitalized patients.
• To assess improvements in insulin order accuracy and adherence to best practices.

Main Methods:

• A quality improvement project implemented a standardized insulin order set across 10 hospitals.
• The order set included fail-safes for insulin-to-nutrition mismatch, basal/bolus coverage, and dose accuracy.
• Primary outcome was hypoglycemia days per 1000 patient-days; secondary outcomes included hyperglycemia and Hemoglobin A1c orders.

Main Results:

• Hypoglycemia days decreased by 24% (13 to 10 per 1000 patient-days, P < .01) across 9 of 10 sites.
• Hyperglycemia days decreased by 16% (90 to 76 per 1000 patient-days, P < .01).
• Hemoglobin A1c ordering improved by 12% (60% to 67%, P < .01).

Conclusions:

• A mandatory, standardized electronic insulin order set effectively reduced hypoglycemia in hospitalized patients.
• The protocol demonstrated value in inpatient diabetes management, though site-specific variations indicate a need for tailored approaches.