Effect of a diabetes order set on glycaemic management and control in the hospital

Abstract

Problem: Insulin can have favourable effects on patient outcomes when used appropriately; however, it is considered among the top five medications associated with errors in the hospital setting.

Setting: Tertiary care centre.

Methods : A diabetes order set with prescribing guidelines was developed by a multidisciplinary diabetes patient safety committee, and introduced on an inpatient unit (the order set unit) following educational sessions with doctors/nurses. To determine the safety and efficacy of the order set, all orders for diabetes medications on patients with 3 days of bedside blood glucose data were recorded and reviewed for types and appropriateness of orders and compared with those written on a unit not using the order set (control unit). An expert panel not involved in the project reviewed and determined appropriateness according to criteria that included evidence of insulin adjustments for hyperglycaemia, hypoglycaemia, or steroid therapy. Satisfaction with the order set among clinical personnel was elicited by a four-item questionnaire.

Results: There were more orders for scheduled basal/bolus insulin therapy (p = 0.008) and fewer orders for correctional insulin alone on the order set unit than the control unit. A trend toward more appropriate orders (91% vs 80%) was observed on the order set unit. A high degree of satisfaction for the diabetes order set was elicited from doctors, nurse practitioners, nurses and clerical staff using a four-item survey.

Conclusions: A diabetes order set with prescribing guidelines can safely and effectively be implemented in hospitals. The success of this intervention is attributed to the contribution of nurses, pharmacists and prescribers in the design and implementation of the order set, the provider education accompanying order set implementation and the feedback following implementation.