Effects of a Computerized Physician Order Entry (CPOE)-Based Inpatient Insulin Protocol on Glycemic Outcomes

Study Overview
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Brief Summary
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Retrospective cross-sectional study measuring the impact of a computer=based insulin correction protocol and nursing inservicing on diabetes outcomes

Detailed Description
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This study is a retrospective cross-sectional study at one institution, where the investigators compared diabetic patients admitted to Medicine Services from March-April 2006 (before CPOE was implemented) to patients admitted from October-November 2007 (one year after CPOE implementation). Capillary blood glucose values, Hemoglobin AIC, diabetes medication profile and demographic data were obtained to compare between groups. The investigators hypothesized that a computer-based protocol that emphasizes basal-bolus and correctional insulin orders and excludes sliding scale, in conjunction with nursing personnel inservicing, improves outcomes.

Official Title
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Effects of a Computerized Physician Order Entry (CPOE)-Based Inpatient Insulin Protocol on Glycemic Outcomes

Conditions
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Diabetes Mellitus

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of Diabetes Mellitus Exclusion Criteria: Admitted to Non-Medicine Hospital Services

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pre-protocol group<br>Group admitted 1 (one) month before CPOE protocol changes were made | |
| Post-protocol group<br>Group admitted 1 (one) year after CPOE protocol changes were made | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Inpatient Glucose | Baseline glucose | From day of admission to hospital until day of discharge from hospital | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of normoglycemic (70 to 150 mg/dl) patient-days | Percentage of inpatient days at glucose target | From day of admission to hospital until day of discharge from hospital | 
| Percentage of hyperglycemic patient-days | Percentage of inpatient days above glucose target | From day of admission to hospital until day of discharge from hospital | 
| Percentage of Patient-days with glucose less than 70 mg/dl | Percentage of inpatient days below glucose target | From day of admission to hospital until day of discharge from hospital | 
| Percentage of Patients with inpatient or recent (less than 6 months) hemoglobin AIC | Percentage of patients with recent A1c | From day of admission to hospital until day of discharge from hospital | 
| Length of stay | Number of days inpatient | From day of admission to hospital until day of discharge from hospital | 
| Distribution of oral hypoglycemic use | Rate of oral diabetes medication use | From day of admission to hospital until day of discharge from hospital | 
| Distribution of type of insulin therapy used | Rate of insulin use | From day of admission to hospital until day of discharge from hospital | 
| Percent of patient-days with severe hypoglycemia | Percentage of patient days with glucose below 55 mg/dL | From day of admission to hospital until day of discharge from hospital | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Inpatient, Computer Physician Order Entry, Diabetes Mellitus