1044-P: A Best Practice Advisory (BPA) Alert within the EHR Reduces Hypoglycemia Related to Insulin Administration in a Real-World Hospital Setting

Basal bolus insulin regimen (BB) is standard practice for managing hyperglycemia. For optimal outcomes with BB, the nursing workflow of timing the point of care glucose (POC-G) measurement with insulin pharmacokinetics is essential. In real-world hospital settings, this is a challenge and can result in iatrogenic hypoglycemia and hyperglycemia. We aimed to improve hypoglycemia by changing nursing practice to reduce the time interval between POC-G measurement and insulin administration. A best practice advisory (BPA) was created to fire within the EHR at the time of insulin administration to alert the nurse to repeat a POC-G if the prior measurement was over 30 minutes for fast acting (FA) or intermediate acting (IA) or over 60 minutes for long acting (LA) insulin. Retrospective data was collected from our hospital system in all hospitalized patients receiving subcutaneous insulin for four months before and after implementation of the BPA. Of total insulin administrations (n=300,462), BPA was fired on 90% (n=270,370) with 94% (n=253,551) acknowledgment rate. The median length of time (LoT) between POC-G and insulin administration pre-BPA to post-BPA decreased from 42 min to 23 min for FA and IA, and from 52 min to 29 min for LA insulin. Concurrently, the median patient days with hypoglycemia defined as POC-G