SAT-844 - Implementation of a Standardized Insulin Discharge Order Set to Reduce Hospital Discharge Prescribing Errors

Background
Medication errors remain an important cause of adverse events, particularly during hospital discharge. Insulin reconciliation is complex as it involves accurate selection of insulin regimens and diabetes supplies. We conducted a quality improvement initiative to evaluate whether a standardized insulin discharge order set, combined with resident education, could improve prescribing accuracy, reduce errors, encourage error reporting, and increase clinician confidence leading to enhanced patient safety during hospital discharge.

Methods
A multidisciplinary team of endocrinologists, pharmacists, and diabetes nurse educators designed and implemented a standardized discharge order set that included preselected diabetes supplies, formulary-based basal and bolus insulin options by insurance coverage, compatible pen needles or syringes, and glucagon rescue products.

An educational workshop introduced the order set and reviewed key principles of discharge insulin prescribing. Internal medicine residents served as their own controls, participating in a pre/post-intervention design that assessed knowledge and confidence in insulin medication reconciliation. Errors after implementation were compared with the pre-intervention baseline.

Results
Confidence improved post-intervention. The proportion of residents very confident with prescribing insulin on discharge increased from 10.3% pre- to 21.1% post- intervention while those not confident at all decreased from 12.8% to 0%. Confidence in prescribing diabetes supplies also improved, with fairly & very confident improving from 51.3% to 89.5%. A modest increase was noted in prescribing insurance-based supplies (private insurance vs medicare/medicaid vs charity care), with improvement in the fairly % very confident proportion from 46.1% to 57.9% and a decrease in those who were not confident at all from 30.8% to 21.2%.

Errors documented for 3 months pre- and post- intervention decreased from 8 total errors to 5, with the most common error pre-intervention being lack of diabetic supplies and insulin vials ordered rather than pens. Post-intervention the greatest error was a complete lack of any diabetic supplies being ordered, meaning the provider skipped using the order set in entirety.

Conclusions
It is evident that resident physicians are confident in the concept of prescribing insulin, however when navigating insurance coverage there were gaps in confidence contributing to errors. With an order set organized by insurance coverage, it reduces errors by lessening the chance that a non-covered option is accidentally ordered. This order set, along with targeted education, was associated with improved prescribing confidence, fewer discharge-related insulin and diabetic supply errors, and an overall enhanced focus on reporting such errors with further feedback being sent to all hospital practitioners.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*