Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3081 — A Computerized Patient Record System (CPRS)-Based Decision Support System for Subcutaneous Insulin Administration in the Inpatient Setting

Sharma S (I.U.S.O.M.) , Chang K (HSR&D,Roudebush V.A.M.C.(Indianapolis)), Taylor P (Roudebush V.A.M.C.(Indianapolis)), Walsh JP (Roudebush V.A.M.C.(Indianapolis))

Aggressive treatment of hyperglycemia in hospitalized patients with insulin has been shown to improve clinically important outcomes. Effective protocols for blood glucose management with intravenous insulin infusions have been described, but there are no protocols for inpatient glucose management with subcutaneous insulin. Our objective was to facilitate safe and effective use of subcutaneous insulin for inpatient blood glucose management through a CPRS-based decision support system.

A Computerized Patient Record System (CPRS)-based decision support system was developed and introduced in 2004 at the Indianapolis VAMC. The system utilizes a series of windows with recommendations for insulin strategies and dosages in common clinical situations. It also provides links to evidence-based quick orders for insulin administration. Resident physician teaching sessions on inpatient glycemic management were also provided.

Inpatient blood glucose data at the Indianapolis VAMC were examined before (2003) and after (2005) implementation of the decision support tool. Data were analyzed by hospital day to ascertain the impact of using the tool over time. Average blood glucoses prior to introduction of the decision support tool increased slightly from 166 mg/dl on day 1 to 171 mg/dl on day 10. In contrast, glucoses after implementation of the system declined steadily from 175 mg/dl on day 1 to 148 mg/dl on day 10. There was no evidence for an increase in the incidence of low blood sugars. Feedback from providers and nursing staff has been positive.

Implementation of the CPRS-based decision support system improved inpatient blood glucose management at our institution.

Based on recent literature, one in five VHA patients have diabetes, and the prevalence is increasing. The CPRS-based decision support system exploits VHA’s rich CPRS technology to present evidence-based recommendations in a user-friendly and easily accessible format. This study demonstrates the feasibility of a subcutaneous insulin protocol to improve glycemic control in a VA inpatient setting. The system has the potential to improve inpatient care and reduce hospital costs by decreasing the morbidity and mortality associated with hyperglycemia.