Impact of a new insulin chart on hospitalised patients with diabetes

Background: Hospitalised patients with diabetes often have poor glycaemic control. To improve the management of hospitalised patients with diabetes, a new insulin chart incorporating documentation of blood glucose levels was developed and introduced at St Vincent's Hospital, Sydney. Aim: To evaluate the impact of a new insulin chart on the management of hospitalised patients with diabetes. Method: A retrospective study comparing the management of three groups of hospitalised diabetic patients. The use of insulin and management of hypoglycaemic events before and after the introduction of the new insulin chart were compared. Clinical data were collected from medical records from April 2004 to April 2005. Chi-square tests were performed to analyse the data for significant differences. Results: Post-implementation of the new insulin chart, patients seen by the endocrine team were more frequently ordered regular insulin (p <0.017) than patients not managed by the endocrinologists. The number of omitted doses of regular insulin remained unchanged. Poor cross-referencing of the insulin and standard medication charts may have been a contributing factor. Post-implementation, significantly more hypoglycaemic events were treated according to the hospital's protocol (p <0.001). Staff satisfaction with the new insulin chart was high except for some doctors' dissatisfaction with the chart when ordering regular insulin. Conclusion: Introduction of the new insulin chart had a positive impact on the management of hypoglycaemic events. Other aspects of diabetes management, such as the number of patients on regular insulin and insulin dose omissions were suboptimal.