PT  - JOURNAL ARTICLE
AU  - A C Donihi
AU  - M M DiNardo
AU  - M A DeVita
AU  - M T Korytkowski
TI  - Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin
AID  - 10.1136/qshc.2005.014381
DP  - 2006 Apr 01
TA  - Quality and Safety in Health Care
PG  - 89--91
VI  - 15
IP  - 2
4099  - http://qualitysafety.bmj.com/content/15/2/89.short
4100  - http://qualitysafety.bmj.com/content/15/2/89.full
SO  - Qual Saf Health Care2006 Apr 01; 15
AB  - 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.