Introduction and Objective: Coordination of point of care test (POCT) blood glucose (BG) check, mealtime insulin administration and meal consumption on busy inpatient units is challenging. Misalignment of these steps can contribute to hyperglycemia and hypoglycemia. To address these challenges, we implemented a hospital-wide mealtime insulin initiative. Methods: Following a pilot on one medical-surgical unit, we launched an interdisciplinary program to improve insulin administration timing which included updated insulin administration instructions specifying timing of insulin relative to meal and BG check, education of nurses, nursing assistants, physicians, advanced practice providers, dieticians, patients and food service delivery staff. Each nursing unit was provided access to their unit’s performance data, and most-improved and top-performing units received awards and recognition. Results: We measured the interval between POCT BG check and insulin administration. Mealtime delivery times were not tracked due to lack of integration with the electronic health record. Prior to implementation, 74.3% of insulin administrations occurred within 60 minutes of POCT BG on medical/surgical units and 44.4% within 30 minutes. Since initiation, the percentage of insulin administrations within 60 and 30 minutes of POCT BG have steadily increased up to 86.0% and 55.1% respectfully at last check. Conclusion: An interdisciplinary mealtime insulin administration initiative has demonstrated a steady improvement in insulin administration timing. Disclosure R.R. Longo: Consultant; Ended; Dexcom, Inc. K. Carithers: None. A. McGregor: None. N. Fulgoni: None. K. Erickson: None. M. Levesque: None.
LONGO et al. (Fri,) studied this question.