SAT103 Strategies To Enhance Insulin Pump Backup Plan Delivery: A Quality Improvement Project
Authors: Krutilova Petra , Blount Sydney , Carvalho Alyssa , Cedeno Andrea , Jones Kai , Malik Is-haq , Rahman Adel Maraqa Sima Abdel , Markov Alexander , Martirossian Alexandra , Petersen Max Christian , Usala Rachel Leigh , Genere Natalia 
Published: October 2023

Abstract
Disclosure: P. Krutilova: None. S. Blount: None. A. Carvalho: None. A. Cedeno: None. K. Jones: None. I. Malik: None. S.A. Maraqa: None. A. Markov: None. A. Martirossian: None. M.C. Petersen: None. R.L. Usala: None. N. Genere: Research Investigator; Self; Fractyl Laboratories.
Background: Continuous subcutaneous insulin infusion (“insulin pump”) use is associated with improved glycemic control, greater quality of life, and reduced hypoglycemic events. However, failure to properly identify and respond to insulin pump malfunction can cause adverse events, including diabetic ketoacidosis. Professional society guidelines recommend the use of insulin pump backup plans in the event of pump failure, but plan details are determined by individual clinicians and practices. We identified inconsistent implementation of insulin pump backup plans within our Diabetes Center and undertook a quality improvement project to (1) standardize backup plan documentation and (2) evaluate the extent to which these efforts improve patient confidence in their personalized backup plan. Methods: Retrospective review of the electronic medical record was performed to evaluate whether all necessary components of an insulin pump backup plan [abbreviated as “WIS”, including (1) Written backup plan with dosing, (2) intermediate or long-acting Insulin prescription, and (3) appropriate Supplies], were documented prior to the intervention. Clinician and patient surveys were completed to gather insights into existing backup plan practices. We then developed a ‘Backup Plan’ document with troubleshooting tips and patient-specific dosing of subcutaneous insulin. We assessed several interventions for increasing utilization of the ‘Backup Plan’ using surveys. Results: In a baseline assessment of 89 patients using insulin pumps, 53% had a documented backup plan and 33% had all WIS components. Certified Diabetes Care and Education Specialist (CDCES) visits were the most common source of pump backup plan documentation and CDCES involvement in care was associated with higher likelihood of successful WIS components (53.3% vs. 11.4%, p &lt;0.001). Yet, only 39% of patients had a CDCES visit within the past year. Of 20 patients surveyed, 85% reported confidence in using their backup plan, but only 50% were able to recall specific insulin dosing. Among several interventions, we found that only personalized training for clinicians improved implementation of the ‘Backup Plan’ document, and none of the interventions increased CDCES referral frequency. Barriers to CDCES visits included patient preference, scheduling constraints, and referral order complexity. Conclusion: We identified low rates of insulin pump backup plan documentation in our practice and identified CDCES engagement as a key factor for backup plan implementation. We developed standardized pump backup plan documentation and implemented it using personalized training of clinicians. In the future, we will pilot a multidisciplinary diabetes technology clinic with allocated time for both clinician and CDCES visits and evaluate frequency of successful pump backup plans through retrospective chart review and patient surveys.
Presentation: Saturday, June 17, 2023