Computerized insulin order sets and glycemic control in hospitalized patients.
Am J Med. 2016 Nov 3;:
Authors: Wong B, Mamdani MM, Yu CH
OBJECTIVE: To evaluate the impact of computerized provider order entry subcutaneous insulin order sets on inpatient glycemic control and ordering behavior.
METHODS: 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 six 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.
RESULTS: 63393 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% versus post-period: 65.3%, p = 0.996). There were no differences in the proportions of moderate or severe hyperglycemia (pre-period: 10.9% versus 12.0%, p = 0.061) and hypoglycemia (post-period: 1.9% versus 1.6%, p = 0.144). 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% versus 55.0%, p < 0.001). Increased basal-bolus-correctional ordering was observed after protocol implementation (20.3% versus 23.6%, p < 0.0001).
CONCLUSIONS: With low institutional uptake, computerized insulin order sets did not improve inpatient glycemic control.
PMID: 27818228 [PubMed - as supplied by publisher]