Arif Sally A, Escaño Alisa K
P T. 2010 Jan;35(1):30-42.
We sought to evaluate barriers to the implementation of a standardized subcutaneous (SQ) insulin order form in a non-ICU medical unit.
An insulin task force comprising physicians, nurses, dietitians, and pharmacists developed and implemented an SQ insulin order form in a community-based teaching hospital. A prospective observational study was conducted to identify difficulties in adopting the form and to delineate requirements for staff education. The main outcome measure was utilization of the form.
The development of a standardized SQ insulin order set for the medical inpatient unit was intended to include a more physiological approach to the control of hyperglycemia. During an eight-week pilot period, only 9% of physician orders included basal, bolus, and correctional-dose (BBC) components of the order form. Because of a limited patient size and low utilization of the order form, it is difficult to determine whether use of the form succeeded in decreasing the occurrence of hyperglycemia. Experience gained from the initial implementation indicates that teaching personnel how to use the form and how to combine long-acting and short-acting insulins to prevent or control hyperglycemia are necessary for the form to gain acceptance.
The extent to which the medical staff used the SQ insulin order form was modest. Clinician acceptance and education about hyperglycemia early on are essential for the successful adoption of a standardized tool into clinical practice.
我们试图评估在非重症监护病房的医疗单元中实施标准化皮下胰岛素医嘱单的障碍。
一个由医生、护士、营养师和药剂师组成的胰岛素工作组在一家社区教学医院制定并实施了皮下胰岛素医嘱单。进行了一项前瞻性观察研究，以确定采用该表单的困难，并明确员工教育的要求。主要结局指标是该表单的使用情况。
为医疗住院单元制定标准化皮下胰岛素医嘱集的目的是采用更符合生理的方法来控制高血糖。在为期八周的试行期内，只有9%的医生医嘱包含了医嘱单中的基础量、大剂量和校正剂量（BBC）部分。由于患者数量有限且医嘱单使用率低，难以确定使用该表单是否成功降低了高血糖的发生率。从最初实施中获得的经验表明，教导工作人员如何使用该表单以及如何联合使用长效和短效胰岛素以预防或控制高血糖，对于该表单被接受是必要的。
医务人员对皮下胰岛素医嘱单的使用程度适中。临床医生早期对高血糖的接受和教育对于将标准化工具成功应用于临床实践至关重要。
