| Principal Investigator: | Van Trinh, PharmD |
| Co-Principal Investigators/Collaborators: | Linda Cook, Diane David, Kevin Erfan, Karl Finley, Mesfin Gebremicheal, Salim Jarawan, Mari Kim, Christine Rawlinson, Darlene Skinner, Diane Van Hassel, Martha Worthington |
| Organization: | Doctors Community Hospital |
Abstract
Problem
Non-standard insulin ordering, administration and monitoring have resulted in unsatisfactory blood sugar levels management and treatment. Hospitalized patients have suboptimal control of their blood glucose levels with the current sliding scale insulin coverage. There were 19 various types of insulin available in the hospital formulary increasing the potential for patient safety issues related to insulin usage.
Evidence
Maintaining a blood glucose level in the 80-110 mg/dL has been proven to decrease hospital length of stay and improve patient outcomes. The Center for the Advancement of Patient Safety and JCAHO have established recommended practices to prevent insulin errors and improve insulin.
Strategy
Establish a multidisciplinary committee to identify insulin administration issues for patients in the emergency department, on in-patient units and patients preparing for surgery. Each of these patient populations has special insulin administration considerations.
Practice Change
Establish pre-printed insulin protocols providing a standard protocol for insulin dosing, correctional dosing and converting patients from continuous intravenous insulin infusion to subcutaneous administration. Correctional doses of short-acting insulin will be individualized based upon the patient’s weight or total daily insulin needs.
Evaluation
The Insulin Committee has been effective in decreasing the available insulins from 19 to 5 and switching from multiple dose vials of insulin to Flexpens.
Results
Blood glucose levels (n= 334) of a random sample of 32 telemetry and medical-surgical patients revealed that 179 (54%) of the blood sugar levels were greater than 150 mg/dL validating the need to individualize pre-prandial dosing. Streamlining of insulin products has lead to decrease.
Recommendations
Additional data will be collected after the protocols are implemented to evaluate the effect on blood glucose management. Develop guidelines for use in pre- and peri-operative patients.
Bibliography
- Hoogwere, B.J.(2006). Perioperative management of diabetes mellitus: How should we act on the limited evidence? Cleveland Clinic Journal of Medicine, 73, supp1, S95–S99.
- Moghissi, E.(2004). Hospital management of diabetes: Beyond the sliding scale. Cleveland Clinic Journal of Medicine, 71(10), 801–808.
- Clinical Practice Guideline for the Inpatient Management of Diabetes/Hyperglycemia in Adults by the Medical Society of Delaware. Retrieved March 2, 2007 from: http://www.dediabetescoalition.org/pdf/InpatientDiabetes.pdf
- Professional Practice Recommendations for Safe Use of Insulin Hospitals by American Society of Health-System Pharmacists. Retrieved February 15, 2007 from: http://www.ashp.org/s_ashp/docs/files/Safe_Use_of_Insulin.pdf
- IV Insulin: The Alchemist’s dream. Is it working!!! By Washington University in St. Louis/Barnes Jewish Hospital Retrieved March 9, 2007 from: http://endo.wustl.edu/conferences/PDFs/Thur-noon-conf/IV%20insulin%20diabetes%20conference%20March%209th,%202006.ppt
- Van den Berghe, G. (2003). Insulin therapy for the critically ill patient. Clinical Cornerstone 5(2)56–63.