Highlights
- •Remote monitoring of blood glucose and insulin orders improved glycemic control.
- •An automated, publicly displayed signal improved insulin prescribing practices.
- •Insulin therapy for hyperglycemia in the absence of diabetes increased hypoglycemia.
- •Algorithm-driven treatment recommendations were safe and effective for patients with diabetes.
Abstract
Aim
The clinical andon board (CAB) is a novel electronic surveillance and communication
system, which alerts providers to and prompts treatment of dysglycemia. This investigation
was designed to determine the CAB’s effectiveness in supporting adherence to standardized
evidence-based protocols, as well as improving glycemic control.
Methods
This study was a retrospective pre/post analysis of insulin orders and blood glucose
values. We used a Student’s t-test for continuous variables and Chi2 for all other variables. This study included patients 18 years or older admitted
to the hospital medical service as an inpatient with a length of stay greater than
24 h and less than 90 days. We used Pearson’s correlation coefficient to evaluate
the relationship between CAB and blood glucose.
Results
The rate of compliance in prescribing basal insulin for patient with diabetes increased
from 56% to 77% (p < 0.001). Similarly, compliance rates for prescribing correctional
insulin in patients without diabetes increased from 15% to 37% (p < 0.001). Performance
on the CAB was linearly related to blood glucose (p = 0.004), and there was a small
statistically (not clinically) significant improvement in mean blood glucose values.
Conclusion
This approach is effective in alerting and engaging providers to prescribe insulin
in a standardized manner with potential to improve glycemic control.
Keywords
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Article info
Publication history
Published online: August 30, 2019
Accepted:
August 29,
2019
Received in revised form:
August 19,
2019
Received:
May 30,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
