Computerized Insulin Order Sets and Glycemic Control in Hospitalized Patients

• Published in: The American journal of medicine Vol. 130; no. 3; pp. 366.e1 - 366.e6
• Main Authors: Wong, Bertha, Mamdani, Muhammad M., Yu, Catherine H.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017; Elsevier Sequoia S.A
• Subjects: Blood Glucose - analysis; Comparative analysis; Computerized provider order entry; Diabetes; Female; Glucometrics; Glucose; Glycemic index; Hospitalization; Humans; Hyperglycemia; Hyperglycemia - epidemiology; Hypoglycemia - epidemiology; Inpatient glucose control; Insulin; Insulin - therapeutic use; Internal Medicine; Male; Medical Order Entry Systems - organization & administration; Medical Order Entry Systems - statistics & numerical data; Middle Aged; Order sets; Patient Safety; Quality of Health Care - organization & administration; Retrospective Studies; Diabetes; Glucometrics; Order sets; Inpatient glucose control; Insulin; Computerized provider order entry
• ISSN: 0002-9343; 1555-7162; 1555-7162
• DOI: 10.1016/j.amjmed.2016.09.034

The purpose of this study was to evaluate the impact of computerized provider order entry subcutaneous insulin order sets on inpatient glycemic control and ordering behavior. This was an interrupted time series study of non-intensive care patients at an urban teaching hospital. The primary outcome was proportion of capillary blood glucose in optimal range (4.0-10.0 mmol/L [72-180 mg/dL]) during the 6 months before and after a change to a computerized provider order entry-integrated insulin order set. Secondary outcomes included other measures of glycemia (hyperglycemia [>13.9mmol/L (250 mg/dL)], hypoglycemia [<4.0 mmol/L (72 mg/dL)], severe hypoglycemia [<2.2 mmol/L (40 mg/dL)]) and ordering behavior (use of basal-bolus-correctional insulin regimens). Comparisons of sensitivity-based versus generic correctional scale were also conducted. A total of 63,393 measurements were obtained from June 2011 to June 2012. Order set usage was limited (51.5%). The weekly proportion of capillary blood glucose within the optimal range was not significantly different after the switch to computerized provider order entry order sets (pre-period: 64.9% vs post-period: 65.3%, P = .996). There were no differences in the proportions of moderate or severe hyperglycemia (pre-period: 10.9% vs post-period: 12.0%, P = .061) and hypoglycemia (pre-period: 1.9% vs post-period: 1.6%, P = .144). However, an increased proportion within the optimal range was seen in those with an order set featuring a sensitivity-based correctional scale versus orders without (65.3% vs 55.0%, P <.001). Increased basal-bolus-correctional ordering was observed after protocol implementation (20.3% vs 23.6%, P <.0001). With low institutional uptake, computerized insulin order sets did not improve inpatient glycemic control.