Paper
Sunday, November 4, 2007
95
Glucose Control Improved in Hospital Hyperglycemia Patients with Standard Insulin Order Set Use
Marvis L. Custer, RN, BSN, MN, Patient Services Division, Education Department, Diabetes Services, OSF St. Joseph Medical Center, Bloomington, IL, USA
| Learning Objective #1: Identify glucose criteria used when deciding to use standardized insulin order sets in hospitalized hyperglycemia patients. |
| Learning Objective #2: Describe glucose outcomes using standardized insulin order sets versus no order sets to control hospitalized patients with hyperglycemia. |
Glucose control decreases hospital morbidity and mortality. Health provider change resistance: preferring traditional “sliding scale” insulin over more effective methods glucose control (basal/bolus; intravenous insulin). Though literature shows basal/bolus subcutaneous or insulin infusion improves glucose control, hospital providers reluctant to use insulin order sets requiring closer glucose management. Questions if glucose control could improve using standardized order sets. Extensive literature regarding benefits of glucose control in the acute care setting distributed. Practice change was needed in hospital’s 32 bed comprehensive care unit. Sliding scale insulin preferred choice for hyperglycemia management. Glucose was below the national 75% average for control (60-150 mg/dl). Open heart surgeons among first to collaborate with hospital’s diabetes CNS to improve glucose control. Staff /Physicians educated about literature, yet, change to order sets (subcutaneous basal/bolus; intravenous insulin) from sliding scale not done. Practice improvement using order sets effective with patients. Widespread order set use for hyperglycemia patients not used per monthly glucose reports. Six Sigma Glucose Control Team implemented to improve outcomes. Of 570 patients admitted July to September 2006, 124 met glucose criteria (criteria defined: 1st Blood Glucose > 200 or 2nd Blood Glucose > 150 mg/dl). Basal/Bolus insulin use 5/124 (4%); 11/124 (9%) insulin infusion use. 88% sliding scale only or no treatment to control initial glucose levels meeting criteria. When order sets used, mean glucose 175; median glucose 149 mg/dl resulted. No action taken mean glucose 206; median glucose 190 resulted. Pvalue = 0.009 indicating statistical difference in mean glucose when order sets followed versus not followed.