The Effects of a Clinical Decision Support Software Program Stability Requirement on Glycemic Outcomes

Abstract

Although dysglycemia has been linked to poor clinical outcomes in hospitalized patients, 30 50% of inpatients continue to have out-of-range glucose values. The use of clinical decision support software to manage intravenous insulin infusions has been well established, but the clinical impact of the ongoing updates and modifications to the proprietary algorithms are not always clear. The purpose of this Doctor of Nursing project was to evaluate a software update implementing a clinical decision support software stability requirement and the effects on blood glucose control in hospitalized diabetic and hyperglycemic adult patients following discontinuation of an intravenous insulin regimen. A retrospective analysis of a before and after cohort evaluated the number of patient days with (a) a mean blood glucose value within the range of 70-180 mg/dL, (b) a blood glucose <40 mg/dL, (c) a blood glucose <70 mg/dL, (d) a blood glucose >180 mg/dL and (e) a blood glucose level >300 mg/dL in patients requiring intravenous insulin during the day of transition and up to three days following discontinuation of intravenous insulin in both a provider discretion cohort (pre-intervention) and a stability requirement cohort (post-intervention). The final data profile resulted in 103 individual patients for the provider discretion cohort and 104 for the stability requirement cohort, with a total n=207. The intervention did not significantly impact glycemic outcomes or clinical process outcomes, except for decreasing variation in provider utilization of transition orders based on pre-admission diabetes control. The results of this study demonstrate the importance of evaluating software updates prior to widespread implementation and beg the question of whether that responsibility should fall on the software creators or the implementation sites.