Rush University Medical Center, Rush Children's Hospital, Chicago, Illinois
Division of Hospital Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
Hosp Pediatr. 2021 Oct;11(10):1163-1173. doi: 10.1542/hpeds.2020-003103.
Insulin is a high-risk medication, and its dosing depends on the individualized clinical and nutritional needs of each patient. Our hospital implemented an insulin dose calculator (IDC) imbedded in the electronic medical record with the goal of decreasing average wait times in inpatient insulin ordering and administration. In this study, we evaluated whether implementation of an IDC decreased the average wait time for insulin administration for hospitalized pediatric patients.
This pre- and postintervention cohort study measured wait times between point-of-care glucose testing and insulin administration. Patients admitted to the inpatient pediatric services who were treated with subcutaneous insulin during the study period were included. Additionally, nurses completed satisfaction surveys on the insulin administration process at our hospital pre- and post-IDC implementation. Descriptive statistics, χ, Fisher's exact test, and Student tests were used to compare groups. Statistical process control charts were used to analyze data trends.
The preintervention cohort included 79 insulin doses for admitted pediatric patients. The postimplementation cohort included 128 insulin doses ordered via the IDC. Post-IDC implementation, the average wait time between point-of-care glucose testing and insulin administration decreased from 37 to 25 minutes ( < .05). The statistical process control chart revealed a 5-month run below the established mean after implementation of the IDC. Before IDC implementation, 15.6% of nurses expressed satisfaction in the insulin-dosing process compared with 69.2% postimplementation ( < .05).
Implementation of an IDC reduced the average wait time in ordering and administration of rapid-acting insulin and improved nursing satisfaction with the process.
胰岛素是一种高风险药物，其剂量取决于每位患者的个体化临床和营养需求。我们医院在电子病历中嵌入了胰岛素剂量计算器（IDC），旨在减少住院患者胰岛素开单和给药的平均等待时间。在这项研究中，我们评估了 IDC 的实施是否降低了住院儿科患者接受胰岛素治疗的平均等待时间。
这项在干预前后进行的队列研究测量了床边血糖检测与胰岛素给药之间的等待时间。在研究期间接受皮下胰岛素治疗并入住住院儿科病房的患者被纳入研究。此外，护士在 IDC 实施前后完成了我院胰岛素给药流程的满意度调查。使用描述性统计、χ²检验、Fisher 确切检验和学生 t 检验来比较组间差异。使用统计过程控制图来分析数据趋势。
干预前队列包括 79 例接受胰岛素治疗的住院儿科患者的胰岛素剂量。实施 IDC 后的队列包括 128 例通过 IDC 开单的胰岛素剂量。实施 IDC 后，床边血糖检测与胰岛素给药之间的平均等待时间从 37 分钟缩短至 25 分钟（<0.05）。统计过程控制图显示，在实施 IDC 后，有 5 个月的运行时间低于既定平均值。在实施 IDC 之前，有 15.6%的护士对胰岛素给药过程表示满意，而实施后这一比例上升至 69.2%（<0.05）。
实施 IDC 缩短了快速起效胰岛素的开单和给药的平均等待时间，并提高了护士对该过程的满意度。
