Interventions to improve insulin prescribing practice for people with diabetes in hospital: a systematic review. Issue 8 (10th June 2019)

• Record Type: Journal Article
• Authors: Bain, A.; Hasan, S. S.; Babar, Zaheer-Ud-Din
• Is Part Of: Diabetic medicine. Volume 36:Issue 8(2019)
• Page Start: 948
• Page End: 960
• Publication Date: 2019-06-10
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13982
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To conduct a systematic review of literature to identify interventions that are effective in improving insulin prescribing for people with diabetes in the hospital setting. Methods: Computerized bibliographic databases were searched for studies published in English that described the effectiveness of interventions to improve insulin prescribing within the hospital setting. Studies were eligible for inclusion if they reported data that compared insulin prescribing practice after an intervention or compared with a control group. Studies were not excluded on the basis of publication date, geographical location or risk of bias assessment. Results: We identified 35 studies for inclusion in the review, including two cluster randomized controlled trials, two cohort studies, and 31 uncontrolled before–after studies. Studies reported a variety of interventions that aimed to increase insulin prescribing accuracy or completeness or decrease the use of discouraged subcutaneous sliding scale insulin regimens. Differences in definition of insulin prescribing error, terminology and common practice based on geographical location was evident, and quality issues with respect to study design and reporting somewhat limited the interpretation of conclusions. Conclusions: Implementing strategies that are sensitive to local context and designed to increase adherence to insulin prescribing guidelines are associated with a reduction in prescribing errors. Future implementation should build on effective approaches including multifaceted interventions involving multiple stakeholders at various institutional levels. Future studies in insulin prescribing errors would benefit from the use of standardized approaches, terminology and outcome measures to enable greater comparison. What's new?: Medication errors involving insulin are common and costly. Organizations have adopted various approaches to reduce insulin prescribing errors, and improve the safe use of insulin for people with diabetes in hospital. This is the first systematic review to identify interventions to improve insulin prescribing practice for people with diabetes in hospital. Quality improvement interventions vary in their ability to improve insulin prescription accuracy, clarity and adherence to guidelines. Strategies that involve multiple interventions with organizational support are more successful than single, optional interventions undertaken by one professional group. Quality improvement reports with rigorous methodology and reporting quality are needed, along with a standard approach to defining insulin prescribing errors in hospital.