2.3.0.0 Physi­cian Order Entry

Rec­om­men­da­tion

15.2 In­sulin should be ad­min­is­tered using val­i­dat­ed writ­ten or com­put­er­ized pro­to­cols that allow for predefined ad­just­ments in the in­sulin dosage based on glycemic fluc­tu­a­tions. E

The Na­tion­al Acade­my of Medicine rec­om­mends CPOE to pre­vent med­i­ca­tion-‍re­lat­ed er­rors and to in­crease efficien­cy in med­i­ca­tion ad­min­is­tra­tion (9). A Cochrane re­view of ran­dom­ized con­trolled tri­als using com­put­er­ized ad­vice to im­prove glu­cose con­trol in the hos­pi­tal found significant im­prove­ment in the per­cent­age of time pa­tients spent in the tar­get glu­cose range, lower mean blood glu­cose lev­els, and no in­crease in hy­po­glycemia (10). Thus, where fea­si­ble, there should be struc­tured order sets that pro­vide com­put­er­ized ad­vice for glu­cose con­trol. Elec­tron­ic in­sulin order tem­plates also im­prove mean glu­cose lev­els with­out in­creas­ing hy­po­glycemia in pa­tients with type 2 di­a­betes, so struc­tured in­sulin order sets should be in­cor­po­rat­ed into the CPOE (11).