Implementation of a Multihospital Electronic Medical Record–Based Insulin Order Set to Reduce Hypoglycemic Events
Year: 2025
Type: article
Abstract: Introduction Glycemic control in hospitalized patients with diabetes is crucial, yet remains challenging. Hypoglycemia poses increased risk of complications, prolonged stays, and mortality. Strategies such as basal-bolus-correction insulin can help balance glycemic control and reduce hypoglycemic events. This study evaluated the impact of a mandatory electronic medical record (EMR)-based insulin order set across a multihospital system. Methods This quality improvement project was implemented at 10 hospitals in North Carolina, including urban, rural, and community sites. The intervention introduced a standardized insulin order set with multiple fail-safes addressing insulin-to-nutrition mismatch, basal and bolus coverage, and dose accuracy. The primary outcome was hypoglycemia days per 1000 patient-days in non-pregnant adults. Secondary outcomes included hyperglycemia days and the rate of hemoglobin A1c (HgbA1c) orders. Results Hypoglycemia days across all sites decreased from 13 to 10 per 1000 patient-days (24% reduction; p < 0.01), with nine sites showing declines (7–39%) and one site showing an increase. Hyperglycemia days decreased from 90 to 76 per 1000 patient days (16% reduction; p < 0.01). HgbA1c ordering improved from 60% to 67% (12% increase, p < 0.01). Discussion The implementation of a system-wide EMR-based insulin order set reduced hypoglycemia rates across nine out of ten hospitals without adversely affecting hyperglycemia. The standardized protocol contributed to these improvements. Site specific variations in outcomes may suggest the need for tailored interventions in certain locations. Conclusion Implementation of a mandatory, standardized insulin order set with multiple fail-safes across a multihospital system effectively reduced hypoglycemic events, thus demonstrating their value in managing inpatient diabetes.
Source: AACE Endocrinology and Diabetes
Authors: Domenic DiSanti, April Goley, Avni Garg, Bonnie Alexander, Tracie Rivet, Leonardo Marucci, Natascha Lautenschlaeger, Clare Kneis, Chris Parker, Lawrence B. Marks, Morgan S. Jones
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7083009904