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OBJECTIVES Insulin is a high-risk medication, and its dosing depends on the individualized clinical and nutritional needs of each patient. Our hospital implemented an insulin dose calculator (IDC) imbedded in the electronic medical record with the goal of decreasing average wait times in inpatient insulin ordering and administration. In this study, we evaluated whether implementation of an IDC decreased the average wait time for insulin administration for hospitalized pediatric patients. METHODS This pre- and postintervention cohort study measured wait times between point-of-care glucose testing and insulin administration. Patients admitted to the inpatient pediatric services who were treated with subcutaneous insulin during the study period were included. Additionally, nurses completed satisfaction surveys on the insulin administration process at our hospital pre- and post-IDC implementation. Descriptive statistics, χ2, Fisher’s exact test, and Student t tests were used to compare groups. Statistical process control charts were used to analyze data trends. RESULTS The preintervention cohort included 79 insulin doses for admitted pediatric patients. The postimplementation cohort included 128 insulin doses ordered via the IDC. Post-IDC implementation, the average wait time between point-of-care glucose testing and insulin administration decreased from 37 to 25 minutes (P < .05). The statistical process control chart revealed a 5-month run below the established mean after implementation of the IDC. Before IDC implementation, 15.6% of nurses expressed satisfaction in the insulin-dosing process compared with 69.2% postimplementation (P < .05). CONCLUSIONS Implementation of an IDC reduced the average wait time in ordering and administration of rapid-acting insulin and improved nursing satisfaction with the process.

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Background: To decrease delays in inpatient insulin ordering and administration, our children’s hospital implemented an insulin-dose-calculator (IDC) imbedded in the electronic health record. A multidisciplinary team developed the IDC, modeling it after a similar tool in place at another children’s hospital. 1 This calculator provides an innovative approach to the complex and time-consuming process of dosing, ordering, and administering rapid-acting insulin in the inpatient setting. Prior to implementation of the IDC, rapid acting insulin dosing, ordering, and administration required 7-steps with 6 identified areas of delay. The IDC streamlined this into a 4-step process, eliminating 5 out of 6 areas of delay. Here, we describe the benefits of an insulin dose calculator in terms of efficiency, safety, and overall streamlining of inpatient care of insulin-dependent diabetic patients. Methods: This pre- and post- implementation cohort study measured delays between (1) point-of-care (POC) glucose testing and insulin ordering and (2) between POC glucose testing and insulin administration. The pre-implementation cohort included pediatric patients receiving insulin admitted to our hospital between 2011 and 2017 (n=644). Those who received insulin via the IDC will be included in the post-implementation cohort. Pre- and post-implementation delays were compared to determine the impact of the tool on patient care and hospital efficiency. Additionally, pre- and post-implementations surveys were completed by the pediatric nursing staff to capture data on nursing and patient satisfaction. Finally, insulin-related safety events were collected pre-and post-implementation. Results: Prior to implementation of the IDC, the average delay between POC glucose testing and insulin ordering was 22 minutes. The average delay between POC glucose testing and insulin administration was 37 minutes. Preliminary data at the time of this abstract submission supports a decrease in the delay between POC glucose testing and insulin administration after implementation of the IDC tool. Results from the pre-implementation nursing survey revealed that 75% of nurses were dissatisfied with the previous process and that they perceived most patients were dissatisfied as well. Conclusion: Implementation of an IDC tool will minimize delays in ordering and administering of rapid-acting insulin, as well as increase nursing satisfaction, while maintaining a safe system for insulin dosing. 1. Aiyagari R, Moran C, Singer K, Ateya M. Insulin Bolus Calculator in a Pediatric Hospital.  Applied Clinical Informatics . 2017;08(02):529-540. doi:10.4338/aci-2016-11-ra-0187.