Erratic blood glucose levels (BGL) are commonly observed amongst patients with diabetes mellitus during hospital admission. Patients on insulin therapy often do not have their doses titrated adequately by their team doctors during admission, and insulin is well-known to be a high risk medication prone to administration error. The aim of this study is to assess the impact of a state-wide Adult Subcutaneous Insulin Prescribing Chart (ASCIPC) on glycaemic control and insulin prescribing pattern in a tertiary hospital.
An audit on the clinical records of in-patients who were on subcutaneous insulin therapy in the first week of July 2014 (prior to ASCIPC, n = 56) and in the first week of July 2015 (10 months after introducing ASCIPC, n = 62) was conducted at Liverpool Hospital.
Following introduction of ASCIPC, fewer BGL readings were missed (9.1 vs 11.6%, p = 0.032) and medical officers were more likely to adjust insulin dosage (71.0 vs 42.6%, p = 0.002) when compared to baseline. Glycaemic control improved, with lower mean BGL (9.4 ± 2.0 vs 10.4 ± 2.6 mmol/L, p = 0.021) and greater proportion of BGLs within the normal range of 5-10 mmol/L (56.2 vs 47.7%, p = 0.041). Omission of insulin doses after ASCIPC remained common, with over 40% of patients having at least one dose of insulin omitted during the audit week.
Our study showed that introduction of ASCIPC had positive impacts on glycaemic management for patients on subcutaneous insulin therapy during admission. More work is required to reduce the rate of insulin omission and to further improve glycaemic control for in-patients.