Catherine Hy Yu, MD, MHSc1,2,3; Karlos Sun, BSc4; Rosane Nisenbaum, PhD1,3,5; Henry Halapy, PharmD4
1 Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, St. Michael’s Hospital, Toronto, Ontario. 2 Department of Medicine, Faculty of Medicine, University of Toronto. 3 Dalla Lana School of Public Health, University of Toronto. 4 St. Michaels’ Hospital, Toronto, Ontario. 5 Centre for Research on Inner City Health, St. Michaels’ Hospital, Toronto, Ontario
Avoidance of hyperglycemia in the peri-operative period can improve patient outcomes, and may be achieved with standardized insulin order sets. We found that a standardized order set, in the context of a multi-faceted interprofessional intervention, reduced hyperglycemia and improved nursing satisfaction and processes of care. Universal uptake of the order set was facilitated by a comprehensive implementation strategy which included stakeholder engagement, institutional support, case-study driven educational sessions, and printed reminders and enablers.
Objective: To evaluate the impact of a standardized pre-printed subcutaneous correctional insulin order set on glycemic control, processes of care and nursing satisfaction.
Design: Controlled before-after study, qualitative study using focus group interviews.
Participants: The intervention group consisted of patients with diabetes admitted to the cardiovascular surgery ward. The control group consisted of patients with diabetes admitted to the vascular surgery ward. Registered nurses on the cardiovascular surgery floor participated in focus groups and completed surveys.
Intervention: We employed a multi-faceted intervention including standardized insulin order sheet, educational workshops, verbal and printed reminders, printed enabler, reference sheet and overnight helpline.
Outcomes: Glycemic control and hypoglycaemia were assessed through chart review while nursing satisfaction with the insulin order sets was assessed through surveys and nursing focus groups, performed pre— and 6 month post-implementation of the insulin order set.
Results: There was a 39% reduction in proportion of blood glucose > 11.0 mmol/L (198 mg/ dL) in the intervention group compared to control group (0.17 vs 0.28, p=0.03). The proportion of hypoglycaemia (blood glucose < 4.0 mmol/L (72 mg/dL)) was no different between the two groups. Nurse satisfaction increased significantly (p<0.02); they were easy to use and improved glycemic control, processes and efficiency of care, and reduced the number of pages between nursing and medical staff.
Conclusions: Standardized insulin order sets reduced hyperglycaemia and improved nursing satisfaction and processes of care. Successful implementation required stakeholder engagement, identification of barriers and facilitators in local practice and tailoring the intervention to target these factors.
No disclosures to declare