Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 23

23 - DEFICIENCIES IN THE DISCHARGE PROCESS OF PATIENTS WITH DIABETES USING INSULIN PENS

Thursday, Apr 25
12:00 PM – 12:30 PM

Objective :

The transition from the hospital to outpatient settings of patients with diabetes on insulin therapy is a critical time, and prone to errors and potential adverse events. Insulin pen use improves adherence and dosing accuracy, however, its requires an associated pen needle. We aimed to identify the proportion of patients discharged on insulin pens receiving an associated pen needle prescription, and analyzed the impact of implementing a system-wide electronic medical record physician prompt. 


Methods : Adult patients with diabetes receiving a prescription for insulin pens at discharge from Emory-affiliated hospitals (n: 6) discharged from May 25th, 2017 to September 30th, 2018 were included. Only the first admission was included. We excluded non-insulin pen prescriptions, insulin vial prescriptions and those receiving no prescription. We compared baseline clinical characteristics between patients with and without an associated pen needle prescription before and after our prompt go-live date of May 25, 2018. 


Results :

Among 773 patients included before the intervention, only 48% (n: 369, mean age 54 ±16 years, 57% male, 66% African-Americans) received both prescriptions at discharge. Mean admission glucose (368 ± 231 vs 295 ± 187 mg/dl) and hemoglobin A1c (HbA1c 10.7 ± 3 vs 9.7 ± 2.8%) were significantly higher in the group with both prescriptions compared to those without pen needles prescriptions, p<0.001. Less patients discharged on basal insulin alone (26 vs 42%) or to a rehabilitation facility (1.1 vs 6.2%) received both prescriptions, p<0.01. Receiving inpatient diabetes education doubled (60% vs 30%, p<0.001) the proportion of patients receiving both prescriptions. 


Discussion :

The admission glucose, HbA1c, BMI, and insulin regimen were no different in the pre-intervention (n: 773) and post-intervention groups (n: 244), all p>0.05. Notably, the implementation of an EMR prompt significantly increased the proportion of patients receiving both prescriptions (61% vs 48%, p<0.001. 


Conclusion : Less than 50% of patients discharged on insulin pens from acute care hospitals received a pen needle prescription. Inpatient diabetes education and implementing an “EMR physician prompt” could improve such discharge deficiencies. Further studies analyzing readmissions and/or emergency room visits will follow. 

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Neil Dhruv

Medical Student
Emory University School of Medicine
Peachtree City, Georgia

Neil Dhruv is currently a medical student at the Emory University School of Medicine, and a former post-doctoral research fellow in the Division of Endocrinology and Diabetes.

Ethan Molitch-Hou

Assistant Professor of Medicine
Emory University School of Medicine

Dr. Molitch-Hou is an Assistant Professor in the Division of Hospital Medicine, Emory University School of Medicine.

Maria Klimenko

Assistant Professor of Medicine
Emory University School of Medicine

Dr. Klimenko is an Assistant Professor of Medicine in the Division of Hospital Medicine, Emory University School of Medicine.

Heqiong Wang

Biostatistician
Rollins School of Public Health, Emory University

Heqiong (Maggie) Wang, MD (Tongji Medical College, China), MPH (University of Florida), is a Biostatistician in the Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University. She spends her time collaborating with the Biostatistics Collaboration Core (BCC), Grady diabetes group, and a clinical trial group by providing initial consultation, programming, data management, and data analysis. Maggie is the BCC expert on utilizing large databases, including Truven’s MarketScan, to determine prevalence and cohort available for rare disease research questions, to develop analytic datasets, and to utilize in data analysis

Rodolfo J. Galindo

Assistant Professor of Medicine
Emory University School of Medicine
Atlanta, Georgia

Dr. Galindo graduated from the Institute of Medical Sciences at the University of Havana, Cuba. He completed his Internal Medicine residency at the Albert Einstein College of Medicine and an Endocrinology fellowship at North Shore University Hospital in New York. After completing fellowship, he was recruited as an Assistant Professor of Medicine by The Mount Sinai School of Medicine in New York City. In this position, he was appointed “Director of the Inpatient Diabetes Service” and “Medical Chair of the Diabetes Taskforce” at Mount Sinai St’ Luke and West Hospitals. He then joined the faculty of the Division of Endocrinology of Emory University in 2017, to work with his mentor Dr. Guillermo Umpierrez, who is an internationally known researcher for his contributions in the area of inpatient diabetes management. Dr. Galindo’s research focuses on translational studies and clinical trials in the area of management of diabetes in the hospital and in patients with post-transplantation diabetes (PTDM/NODAT). He currently serves as the chair of the Hospital Diabetes Taskforce of Emory Healthcare System. He is the recipient of numerous awards from the Endocrine Society, the “FLARE award: Future Leaders in Advancing Research in Endocrinology”, the American Diabetes Association, the Endocrine Fellows Foundation and the prestigious “Leo M. Davidoff Award” for outstanding teaching of Einstein’s medical students. His research has been published in leading peer-reviewed journals and presented at the international scientific meetings of the ADA, Endocrine Society and AACE.