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Abstract
Background: Poor glycemic control is associated with negative outcomes in hospitalized patients with diabetes, both during and beyond their hospital stay. Despite its limitations, adjunct sliding scale insulin (SSI) is often prescribed to manage glucose levels, but the regimens are subject to wide variability and may contribute to medication error. Objective: To evaluate diabetic patients' glycemic control and staff acceptability following development and implementation of an SSI preprinted order (PPO). Methods: A retrospective chart review of diabetic patients admitted to the adult internal medicine service at a major Canadian teaching hospital was conducted. A convenience sample of patients who received SSI before (n = 60) and after (n = 60) PPO implementation was evaluated for episodes and management of hypo- and hyperglycemia. A survey also was conducted to determine staff perspectives regarding SSI PPO use. Results: Thirty-five SSI regimens were identified among the 60 patients in the pre-PPO group. Although no significant difference in the incidence of hypoglycemia was found between groups, more hyperglycemia episodes occurred in the post-PPO group. Glycemic control was poor regardless of the SSI prescribing strategy employed; only half of the measurements in either group were within a 72–198 mg/dL target range. One-third of medical students reported receiving no prior teaching for devising an SSI regimen. Both medical and nursing staff reported increased clarity and ease in administering SSI with use of a PPO. Half of the respondents believed that the potential for medication error was diminished. Conclusions: A PPO decreased variability in SSI prescribing but did not improve glycemic control in diabetic patients admitted to internal medicine. Revisions to our documents have been made to address hyperglycemia events and appropriate SSI use to further promote patient safety through standardized prescribing.
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Affiliation(s)
- Kerry Wilbur
- KERRY WILBUR BSc(Pharm) ACPR PharmD, Clinical Pharmacist Specialist,
Internal Medicine, Pharmaceutical Sciences, Vancouver General Hospital, Vancouver,
British Columbia, Canada; Clinical Associate Professor, Faculty of Pharmaceutical
Sciences, University of British Columbia, Vancouver
| | - Christine Yu
- CHRISTINE YU BSc(Pharm) ACPR, Hospital Pharmacy Resident, Faculty of
Pharmaceutical Sciences, University of British Columbia
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Generali J. Announcing a New Feature in Hospital Pharmacy: Standardized Drug Prescribing Forum. Hosp Pharm 2006. [DOI: 10.1310/hpj4102-110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joyce Generali
- Drug Information Center, Kansas University Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160
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