Safety and Clinical Outcomes of Using an Automated Order Set IV-SC Insulin Conversion in Hospitalized Patients: A Retrospective Cohort Study
Objective: Two patient-groups (using, not using an automated order set) were compared for outcomes (differences in hypoglycemic events, hyperglycemic events, glucose-levels after IV- SC insulin conversion). Methods: A retrospective cohort-study of automated order set versus non-order set critical-care patients receiving IV-insulin for at least 24-hours from January-May, 2014. Data) included patients’ age, race, comorbidities, IV-SC insulin conversion criteria (nutritional-status, prednisone-use, hypoglycemia-risk, and estimated-glomerular-filtration-rate), IV/SC insulindoses, and outcomes (glucose-levels, number of hyperglycemic and hypoglycemic events,). A hypoglycemic and hyperglycemic event were each defined as a glucose level “<70 mg/dL counted every 2 hours” and “>180 mg/d counted every 3 or 8 hours”, respectively. Results: The differences between 24-hours post- minus pre- IV-SC conversion in 37 order set versus 59 non-order set patients were: 1) hypoglycemic events (percentage of patients with more events; 8%vs.5%, p>0.05) 2) hyperglycemic events at 8-hour window (percentage of patients with more events, 11%vs.32%,p=0.0171) and 3) average blood-glucose levels (median- difference 2.13 vs.15.46 mg/dL, p>0.05). Conclusions: Despite the small sample size, the study demonstrated smaller (non-significant) fluctuations in blood glucose levels and significantly fewer hyperglycemic events in eligible automated order set vs. non-order set IV-SC converted patients. Providers using automated order sets for IV-SC conversion may get better clinical and safety outcomes.
Jayashri Sankaranarayanan*, Kyle Lundgren, Carrie Margeson, Mary Poonnose, Alicia Williams, Nicholas Tessier
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