Summary
Introduction
Objectives: Despite evidence documenting their ineffectiveness, sliding scale insulin is a commonly
used regimen for glucose management for hospitalized patients with diabetes mellitus.
At the Veterans Affairs Puget Sound Medical Center, where computer order entry has
been mandated, we tested the hypothesis that an evidence-based minimal intervention
order (supplemental insulin only when fasting serum glucoses exceeded 400 mg/dl) would
decrease the use of sliding scale insulin orders.
Methods: Using a computerized order entry system, providers were initially offered a traditional
sliding scale order or their own ad hoc orders for glycemic control of inpatients.
After 34 weeks providers were offered a third option; a “minimal intervention order”
with supplemental insulin only for glucose >400 mg/dl. We extracted all regular insulin
orders and performed a retrospective review of insulin sliding scale orders written
between December 1, 1998 and November 16, 1999. We compared the frequency of traditional
insulin sliding scale orders before and after the introduction of the minimal intervention
order.
Results: Nearly all orders in the first 34 weeks were traditional insulin sliding scales.
We found a significant decrease in the number of traditional insulin sliding scale
orders in the 16 weeks after the introduction of a computerized quick-order for minimal
intervention, from 978/1007 (97.1%) to 254/398 (63.8%) (P <0.001).
Conclusions: A simple, evidenced-based quick-order in a computer order entry system rapidly and
significantly reduced use of sliding scale insulin regimens for glycemic control of
inpatients.
Keywords
Medical records systems - computerized - diabetes mellitus - physicians practice patterns
- insulin
