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Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin
  1. A C Donihi,
  2. M M DiNardo,
  3. M A DeVita,
  4. M T Korytkowski
  1. University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  1. Correspondence to:
 A C Donihi
 Department of Pharmacy and Therapeutics, University of Pittsburgh, 302 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA 15213, USA; calabresea{at}upmc.edu

Abstract

Problem: Sliding scale insulin (SSI) is frequently used for inpatient management of hyperglycemia and is associated with a large number of medication errors and adverse events including hypoglycemia and hyperglycemia.

Design: Observational before and after study evaluating the impact of implementation of a standardized SSI protocol and preprinted physician order form.

Setting: University Hospital in Pittsburgh, PA, USA.

Strategy for change: Guidelines for the use of SSI were created by an interdisciplinary committee and implemented in non-intensive care units. In addition, a preprinted physician order sheet was developed which included the guidelines and an option for ordering one of three standardized insulin sliding scales or a patient specific scale.

Effect of change: One year after implementation the physician order form was used for 91% of orders and, overall, 86% of SSI orders followed the guidelines. The number of prescribing errors found on chart review was reduced from 10.3 per 100 SSI patient-days at baseline to 1.2 at 1 year (p = 0.03). The number of hyperglycemia episodes 1 year after implementation decreased from 55.9 to 16.3 per 100 SSI patient-days.

Lessons learnt: The protocol was readily accepted by hospital staff and was associated with decreased prescribing errors and decreased frequency of hyperglycemia.

  • SSI, sliding scale insulin
  • SSR, sliding scale regular insulin
  • insulin
  • medication errors
  • hyperglycemia
  • practice guidelines
  • SSI, sliding scale insulin
  • SSR, sliding scale regular insulin
  • insulin
  • medication errors
  • hyperglycemia
  • practice guidelines

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Footnotes

  • Competing interests: M T Korytkowski has received the following from pharmaceutical companies that make insulin in the past five years: (1) consulting fees from Eli Lilly, (2) consulting fees and honoraria for speaking from Novo Nordisk, (3) honoraria for speaking engagements from Aventis, and (4) grant support from Aventis. There are no other competing interests to declare.

  • Parts of this study were presented as posters at the 38th American Society of Health-System Pharmacists Midyear Clinical Meeting, New Orleans, LA in December 2003 and the American Diabetes Association 64th Annual Scientific Sessions, Orlando, FL in June 2004.

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