Reduction of Insulin Related Preventable Severe Hypoglycemic Events in Hospitalized Children

Abstract

OBJECTIVE Insulin is a commonly used, high-risk medication in the inpatient setting. Incorrect insulin administration can lead to preventable hypoglycemic events, which are a significant morbidity in inpatient diabetes care. The goal of this intervention was to decrease preventable insulin-related hypoglycemic events in an inpatient setting in a tertiary care pediatric hospital. METHODS Methods included the institution of several interventions such as nursing and physician education, electronic medical record order sets, electronic communication note templates, and the development of new care guidelines. RESULTS After the institution of multiple interventions, the rate of preventable hypoglycemic events decreased from 1.4 preventable events per 100 insulin days to 0.4 preventable events per 100 insulin days. CONCLUSIONS Through the use of a multi-interventional approach with oversight of a multidisciplinary insulin safety committee, a sustained decreased rate of severe preventable hypoglycemic events in hospitalized pediatric patients receiving insulin was achieved.

A Quality Initiative Reducing Adverse Outcomes in Pediatric Patients with DKA During Intrafacility Transit

“…8–10 This regimen mitigates the high risk of continuous insulin resulting in hypoglycemia, which can lead to altered mental states, seizures, coma, prolonged length of stay, and possibly cerebral edema. 11,12 A lack of monitoring is a chief cause of medication-related ADEs. 15 Given our institutional history for lapses in blood glucose monitoring, especially in the context of known periods of susceptibility to errors during transition and handoffs, we chose to work on this vulnerable period.…”

“…8–10 A sudden drop in blood sugar can result in altered mental states, seizures, and coma, and has been associated with cerebral edema during DKA treatment. 11,12 Adherence to a slower glucose correction and strict monitoring during DKA treatment is necessary to avoid complications such as hypoglycemia and cerebral edema, which are a major cause of death in children and adolescents presenting with DKA. 13,14…”

Reducing potential errors associated with insulin administration: An integrative review

“…2,15,19 Over the course of 2.5 years, there was a 28% reduction in the rate of severe preventable hypoglycaemic events; the rate of preventable insulin errors reduced from 1.4 to 0.4 events per 100 insulin days after the implementation of electronic medical records and electronic note templates. 15 In a crossover study, the computerized protocols were associated with fewer errors in the titration and transition phases, although there was no difference in the initiation phase between the two protocols. 19 With the computerized protocol, there were only four dosing errors compared to 94 insulin dosing errors with the paper protocols.…”

Orientation in Perpetuity: An Online Clinical Decision Support System for Surgical Residents

“…These include use of computerized order entry to decrease medication errors [16][17][18][19] and standardized "order sets" to reduce mistakes of omission. [20][21][22][23] Clinical decision support services (CDSSs) have been proposed and studied as a more generalized check against errors in patient care. [24][25][26] By contrast, technological innovation designed to support safe, independent clinical decision-making by trainees adapting to new practice environments has not been previously reported.…”