Examining the Influence of Nurse Staffing on Delayed Insulin Administration in Acute Care Settings Using EHR and BCMA...

Delayed insulin administration can lead to poor glycemic outcomes in patients with diabetes. Using EHR and BCMA data, we examined insulin administration patterns across different shifts and types of insulin, and the association between nurse staffing and delayed administration. We analyzed a total of 650 subcutaneous insulin administration events from 96 patients. We found that 42.0% (n=397) of the insulins had delayed administration during 7a-3p shift. Long-acting insulin (Lantus) (64.6%) had more delays than other types of insulin, suggesting that the pharmacokinetics properties of these insulins may influence how nurses prioritized their insulin administrations. We also found that higher patient-to-nurse ratio was associated with delayed insulin administration; however, we did not find nursing skill mix was associated with delays. Lastly, we found patients with delayed insulin administration had poorer glycemic control. Our study demonstrates the need for evidence-based staffing that enables nurses to deliver timely insulin administration during high-demands periods.