Evaluation of an intervention to increase utilization of a subcutaneous basal-bolus insulin protocol

Objectives: To develop educational interventions to increase use of a subcutaneous basal-bolus insulin protocol. Secondary objectives are to 1) provide education about the use of basal-bolus insulin to medical, nursing, and pharmacy staff, 2) evaluate the safety and effectiveness of the basal-bolus insulin protocol compared to a sliding scale insulin protocol, 3) assess appropriate use of the basal-bolus protocol and 4) determine if educational interventions are adequate to maintain increased use of the basal-bolus insulin protocol three months after cessation of educational interventions.

Methods: Educational in-services and handouts were presented to nursing staff, prescribers, and pharmacy staff on basal-bolus insulin use during November 2011. Patients admitted to four adult medical units who received one dose of insulin according to the basal-bolus insulin protocol or the sliding scale protocol during December 2011 and March 2012 were included. Demographics, blood glucose measurements, and information regarding inappropriately held scheduled insulin doses were collected.

Results: Three patients received insulin according to the basal-bolus insulin protocol in December 2011 for a total of 17 patient-days of therapy. The mean blood glucose was 228 mg/dL with two episodes of hypoglycemia (blood glucose < 70 mg/dL). In contrast, 174 patients received insulin according to the sliding scale protocol in December 2011. A random sample of three patients showed a mean blood glucose of 198 mg/dL with no episodes of hypoglycemia over 7 patient-days. Data collection is on-going with a second evaluation period in March 2012. All data analysis will be complete by May 2012.

Conclusion: Utilization of the basal-bolus insulin protocol increased from a baseline of zero in July 2011 to 3 patients in December 2011 showing the impact of the educational interventions. Hospital wide utilization of the protocol has also increased. Full analysis of safety and effectiveness data will be available by May 2012.