Effect of a diabetes order set on glycaemic management and control in the hospital
Effect of a diabetes order set on glycaemic management and control in the hospital
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DOI：
10.1136/qshc.2006.021790
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发表时间：
2008-12-01
影响因子：
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通讯作者：
Korytkowski, M. T.
中科院分区：
文献类型：
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作者：
Noschese, M.;Donihi, A. C.;Korytkowski, M. T.
问题：如果使用得当，胰岛素可以对患者的预后产生有利影响；然而，它被认为是医院环境中与错误相关的五大药物之一。环境：三级医疗中心。方法：一个多学科糖尿病患者安全委员会制定了一套糖尿病处方指南，并在医生/护士的教育会议后引入住院病房（处方集单元）。为了确定订单集的安全性和有效性，记录了所有糖尿病患者3天床边血糖数据的订单，并审查了订单的类型和适当性，并与未使用订单集（对照单元）的订单进行了比较。一个未参与该项目的专家小组根据包括胰岛素调整治疗高血糖、低血糖或类固醇治疗的证据的标准进行审查并确定适当性。通过一份包含四项内容的调查问卷，了解临床人员对所设置的顺序的满意度。结果：与对照组相比，计划基础/大剂量胰岛素治疗的订单量更多（p = 0.008），单独使用矫正胰岛素的订单量更少。在订单集单元上观察到更合适订单的趋势（91% vs 80%）。通过一项四项调查，从医生、执业护士、护士和文职人员中获得了对糖尿病医嘱的高度满意度。结论：以处方指南为基础的糖尿病医嘱可以在医院安全有效地实施。这一干预措施的成功归功于护士、药剂师和开处方者在设计和实施医嘱集、实施医嘱集时的提供者教育以及实施后的反馈方面的贡献。
Problem: Insulin can have favourable effects on patient outcomes when used appropriately; however, it is considered among the top five medications associated with errors in the hospital setting.Setting: Tertiary care centre.Methods : A diabetes order set with prescribing guidelines was developed by a multidisciplinary diabetes patient safety committee, and introduced on an inpatient unit (the order set unit) following educational sessions with doctors/nurses. To determine the safety and efficacy of the order set, all orders for diabetes medications on patients with 3 days of bedside blood glucose data were recorded and reviewed for types and appropriateness of orders and compared with those written on a unit not using the order set (control unit). An expert panel not involved in the project reviewed and determined appropriateness according to criteria that included evidence of insulin adjustments for hyperglycaemia, hypoglycaemia, or steroid therapy. Satisfaction with the order set among clinical personnel was elicited by a four-item questionnaire.Results: There were more orders for scheduled basal/bolus insulin therapy (p = 0.008) and fewer orders for correctional insulin alone on the order set unit than the control unit. A trend toward more appropriate orders (91% vs 80%) was observed on the order set unit. A high degree of satisfaction for the diabetes order set was elicited from doctors, nurse practitioners, nurses and clerical staff using a four-item survey.Conclusions: A diabetes order set with prescribing guidelines can safely and effectively be implemented in hospitals. The success of this intervention is attributed to the contribution of nurses, pharmacists and prescribers in the design and implementation of the order set, the provider education accompanying order set implementation and the feedback following implementation.