Care Gaps in the Administration of Prandial Insulin for Medical Inpatients A Quality Improvement Project

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Shannon Marie Ruzycki
Kirstie Catherine Lithgow
Karmon Helmle
Kara Nerenberg



Background:Inpatient hyperglycemia is associated with multiple adverse outcomes. Lack of coordination between mealtime and insulin delivery can worsen glycemic control.  To date, the logistical challenges at a systems level effecting the timing of insulin administration have not been explored.  

Local Problem:Previous research identified difficulties coordinating prandial insulin delivery with mealtimes as a barrier to euglycemia in hospital.

Aim:Characterize the process of prandial insulin delivery to identify care gaps.

Methods: We used process mapping to describe the prandial insulin delivery on a medical inpatient unit. Nurses were surveyed to identify barriers to insulin delivery.

Results:Short-acting insulins, which should be administered 30 minutes prior to meals, were consistently administered at incorrect times. Nurses identified concerns of hypoglycemia and unpredictable meal delivery times as key barriers to timing of insulin administration.

Conclusions:Environmental and system factors on the inpatient medical units contribute to delayed administration of prandial short-acting insulin.



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