Evidence based insulin therapy for hospitalized patients

Purpose:
Hospitals are reviewing their current practice related to insulin therapy for diabetes mellitus and hyperglycemia,based on evidence that tighter glycemic control improves outcomes. The purpose of the project is to improve management of hospitalized patients utilizing evidence based insulin therapy.

Significance:
There is currently no evidence that utilizing sliding scale insulin practice is effective in controlling hyperglycemia in patients with diabetes. Despite the lack of evidence it is currently still widely used in care. Evidence based insulin therapy orders will improve our glycemic goals and care.

Strategy and Implementation:
Multi-disciplinary teams were identified that could impact glucose control. Benchmarking was done on current practice for insulin administration and glucose control. Multiple workshops were planned in stages over 2 years to increase awareness of improvement in patient outcomes with improved glucose control. Physicians were targeted first and it quickly became apparent that nursing needed a lot of training on insulin therapy regarding basal insulin. New agents and practices have evolved over the past few years and if you were not in a teaching hospital older practices seemed to be in place like sliding scale insulin. This is not evidence based therapy. We were on our Magnet journey and wanted to improve insulin therapy. The planning included a needs assessment, implementation strategies and many workshops for education. There were 3 CME workshops, 4 nusing grand rounds, a on-line continuing learning module, and super user workshops.We did a pilot and it is described below in evaluation.

Evaluation:
A 3 component insulin order set was developed.Review of glucose values from patients admitted from 06/2010 to 08/2010 on the ortho pilot unit.Overall the mean percent of glucose readings maintained between 70-180mg/dl using the order set increased by 10%. 68.8% before the order set and 78.5% after.

Implications for Practice:
The journey for glucose control began in the ICU settings. As we have seen more studies on non-ICU populations it has become apparent that sliding scale insulin therapy in diabetic and hyperglycemia patients will evolve to evidence based insulin therapy using basal, mealtime and correction insulin.