One, a cultural shift among nursing and housestaff on these units may be required for continued change. We hypothesize that many factors may contribute to persistent wait times. From our data analysis, the percentage of doses administered after >30 minutes was 32.3%. Question 6: How satisfied are you with the current process for insulin ordering?Īlthough a significant change in the average wait times between blood glucose measurement and insulin administration was noted in this study, there is room for improvement. Question 5: What percentage of the time is there a discrepancy between the nurse-calculated and provider-calculated insulin dose on the basis of the prescribed sliding scale? Question 4: What percentage of the time do you have to make multiple phone calls to providers regarding an insulin dose? Question 1: How often do patients wait ≥30 min to eat, after food has been delivered to the unit, because of a wait time in insulin ordering? Descriptive statistics, χ 2 tests, Fisher’s exact tests, and Student t tests were used to compare groups. One initial e-mail introducing the survey and 3 reminder e-mails were sent to the nursing pool. Surveys were anonymous, and consent was not obtained. The preimplementation survey was open for 4 weeks in April of 2018, and the postimplementation survey was open for 4 weeks in April of 2019. Surveys were distributed via e-mail to the nursing pool on all 3 hospital units. Finally, nurses were asked to rank their satisfaction with the current process for insulin ordering and administration. Nurses were asked to estimate wait time between meal delivery and insulin order availability, gauge patients’ and/or families’ satisfaction with the wait time associated with insulin processes, estimate how often an insulin dose required multiple phone calls to providers, and estimate the frequency of discrepancy between the nurse-calculated and provider-calculated insulin dose. An anonymous 6-question survey was developed by using Google Forms online software (Alphabet, Inc, Mountain View, CA). To evaluate nursing satisfaction with insulin use at our hospital, pediatric nurses completed a modified 5-point Likert scale survey pre- and post-IDC implementation. P-charts, used for proportional data on doses administered in allotted time frames (60 minutes), were analyzed for successive points outside of the previously established control limits to suggest change beyond special cause variation. An X-bar chart, used for continuous data on average wait times, was analyzed for consecutive points above or below the established mean to identify meaningful change attributable to the implementation of the IDC. Statistical process control charts were plotted for the pre- and postintervention to assess the impact of the IDC tool on process efficiency. Subcutaneous insulin ordering and administration procedures did not differ between hospital units at our institution. Although subcutaneous insulin is administered in the PICU, this usually precedes transfer to a lower level of care. Subcutaneous insulin was primarily used in the general pediatric and psychiatric units. The times between most recent blood glucose measurement, insulin order placement, and insulin administration were extracted from the EMR and medication administration record. This work is a retrospective, observational, pre- and postintervention cohort study.
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