SAT-608 - A Comprehensive Order Set Improves Completeness of Prescriptions for Diabetic Supplies

Introduction:
Diabetes mellitus (DM) is a common condition in hospitalized patients, and patients with DM are often prescribed new or modified pharmacotherapy regimens and/or blood glucose monitoring supplies at the time of discharge. Insulin is a frequently prescribed new medication at discharge, and it can be high-risk if not prescribed appropriately or without the appropriate supplies needed to administer it or to monitor blood glucoses. A comprehensive order set (OS) was developed at our institution with the aim of improving prescribing practices of insulin and glucometer supplies.

Methods:
An OS incorporating the most prescribed insulin pens and vials, pen needles and syringes, glucometers, lancets, and test strips was created and implemented in the electronic health record (EHR), with the goal of providing clinical decision support to providers to encourage completeness and appropriateness of supply prescriptions. Data on prescribing and OS utilization for adult DM patients who were admitted to our institution and were later discharged with a new insulin prescription were extracted from the Epic Clarity database. Given there was an expected increase in completeness of prescriptions, the results were analyzed using a one-tailed two-proportion z-test to assess the statistical significance of the change.

Results:
During the ten months after integration of the OS, new glucometers were prescribed 244 times in our population, and the OS was used 46 times for these. Among the patients prescribed a new glucometer using the OS, 100% of them were also prescribed test strips and 100% of them were also prescribed lancets. Of the patients who were prescribed a glucometer without the OS, 85.8% were prescribed lancets, and 91.4% were prescribed test strips. The proportion of patients who were prescribed lancets and test strips when using the OS showed independent statistically significant differences compared to the proportion of patients prescribed lancets and test strips when the OS was not used (Z-score 2.7; p-value 0.003 for lancets; Z-score 2.05; p-value 0.019 for test strips). Among the patients prescribed insulin pens using the OS, 66% of them were also prescribed pen needles compared to 48.3% when the OS was not used. This was also a statistically significant difference (Z-score 1.71; p-value 0.042).

Conclusions:
We demonstrated the benefit of leveraging EHR tools to facilitate improved prescribing practices and improve completeness of diabetic supply prescriptions for patients transitioning from the inpatient setting to the ambulatory setting with a new initiation of insulin. Limitations of this analysis include the small sample size related to the population assessed. Future directions include increasing awareness and utilization of this tool as well as expanding use of this OS to the ambulatory setting.

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