Standardising practices through form design and education improves insulin management

Abstract

Diabetes is common in hospitalised patients and insulin is frequently required for management. Insulin is a high-risk drug, accounting for about 15% of reported medication-related incidents. Despite its complexity, insulin management in hospitals is often undertaken by junior and nonspecialist staff. Improving insulin management requires addressing safe prescribing and administration as well as quality use of insulin. Common errors in insulin use are well documented and can be addressed through form design and enhancing decision support. We undertook to improve insulin management using a locally proven improvement methodology. New forms were developed for intravenous and subcutaneous insulin and blood glucose management. Audited pilot studies in four hospitals confirmed improved insulin management without adversely impacting on overall diabetes management as assessed using Glucometrics. Subsequently, the forms have been introduced to 70% of Queensland public hospitals with roll-out to remaining hospitals continuing. Large-scale standardisation of insulin manage-

Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review

“…The introduction of simple, small focused interventions led to an improvement in the completeness and accuracy of insulin prescribing, particularly when they involved ‘hard stops’ (such as pre‐printing ‘units’ on dedicated insulin prescription charts to avoid misinterpretation of ‘u’) . McIver et al .…”

“…McIver et al . implemented a standardized insulin prescribing form incorporating pre‐printed ‘units’ and mealtime associations . As a result, they reported a reduction in the opportunity for error as a result of non‐standard abbreviations from 41.8% to 12.2% and as a result of unclear frequency from 65.9% to 6.5%.…”

“…All were uncontrolled before-after studies. Four studies were multisite [19,28,30,32], seven involved teaching or tertiary hospitals [26][27][28][29][30][31]33] and three studies involved district general hospitals [18,19,25].…”

Introduction of New South Wales adult subcutaneous insulin‐prescribing chart in a tertiary hospital: its impact on inpatient glycaemic control

“…Other studies had assessed the effectiveness of an insulin‐prescribing chart. In Queensland, an intravenous as well as subcutaneous insulin chart had been developed, and although glycaemic control was not significantly different following the introduction of the subcutaneous insulin chart, there was improvement in the clarity of insulin prescription and the frequency of usage of supplemental insulin . Cheung et al performed an audit on their locally developed subcutaneous insulin chart, which was similar to the NSW ASCIPC .…”

“…In Queensland, an intravenous as well as subcutaneous insulin chart had been developed, and although glycaemic control was not significantly different following the introduction of the subcutaneous insulin chart, there was improvement in the clarity of insulin prescription and the frequency of usage of supplemental insulin. 10 Cheung et al performed an audit on their locally developed subcutaneous insulin chart, which was similar to the NSW ASCIPC. 11 Following the introduction of their insulin chart, Cheung et al reported an increase in the number of BGL performed daily and a higher proportion of BGL between 4.0 and 9.9 mmol/L (54.1 vs 51.8%, P = 0.01).…”