Standardizing sliding scale insulin orders.

The objective of this study was to decrease variation in an inpatient setting in diagnosing and treating patients with a secondary diagnosis of type II diabetes mellitus. Physician ordering practices were reviewed in a 262-bed acute care hospital with 489 physicians on the active medical staff. Using standard quality improvement methodology, the diagnosis of and care of hyperglycemia and type II diabetes mellitus was analyzed and changes in ordering practice recommended. Standardized sliding-scale orders were implemented with widespread staff acceptance as demonstrated by 80% use after 6 months, and over 500 undiagnosed hyperglycemic patients will be counseled in 2001. The costs for the program were more than covered by the estimated annualized savings of 687 bed days and $134,832. This project demonstrates that standardizing care for inpatients with type II diabetes mellitus is possible. The cost savings (not including the value of good will and perceived increase in quality by the patients) justifies the time and effort to make these changes.