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Purpose: Standardization of subcutaneous Insulin sliding scale (ISS), since, Insulin is considered one of the top five “high alert” medications because errors in dosing and administration can result in severe adverse effects; Insulin is one of the drugs most likely to be involved in errors. Currently at KFMC, we have 19 different forms for (ISS), therefore, our plan: 1- Evaluate current practice, 2- Standardize ISS through preprinted order, 3- Evaluate the impact after implementation of a Correctional ISS in preprinted order (PPO)
Methods: Observational evaluations of sliding scale Insulin. A chart of 50 before and 50 patients after the PPO implementation were evaluated for episodes and management of hypo- and hyperglycemia.
Results: Our evaluation on current ISS protocols showed significant failure to achieve euglycemia. 36 % (18) were on sliding scale insulin for more than one week without adding basal therapy. Guidelines for the use of Correctional Insulin Sliding Scale were created by an interdisciplinary team and implemented in non-intensive care units. In addition, a preprinted physician order sheet was developed which included the guidelines and an option for ordering one of four standardized insulin sliding scales. Three month after implementation the physician order form was used for 95% of orders. The number of prescribing errors found on chart review was reduced from 15 % at baseline to 2 % at three months. The number of hyperglycemia episodes 3 months after implementation decreased from 17 % to 6 %.
Conclusion: The preprinted order was readily accepted by hospital staff and was associated with decreased variability in ISS prescribing and decrease frequency of hyperglycemia.