SHM Converge Scientific Abstract ePoster Gallery-Discharing People With Diabetes on Insulin: We Must Do Better

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The document describes a study from the University of Nebraska Medical Center examining how insulin is prescribed at hospital discharge for patients with diabetes. It highlights that insulin is a high-risk medication and that transitions from hospital to outpatient care are especially prone to prescribing errors, which can harm patients—particularly older adults.<br /><br />The project aimed to review current discharge insulin practices among hospital medicine providers, identify errors, and propose improvements. Methods included a provider survey of hospitalists, advanced practice providers, and residents, as well as a retrospective chart review of patients discharged from the hospital medicine service over a three-month period. Patients on insulin pumps, those leaving against medical advice, transferred patients, and hospice discharges were excluded.<br /><br />Key findings showed significant gaps in discharge care. Many providers did not consistently include diabetes supplies or discharge instructions, and when instructions were provided, some were inaccurate. Insulin regimen changes at discharge were not consistently based on HbA1c, despite ADA guidance recommending intensification when appropriate. Non-insulin diabetes medications were rarely adjusted even in patients with elevated HbA1c. Follow-up with primary care or endocrinology often did not lead to changes in insulin regimens. About 26% of patients were seen in the ED or readmitted within 30 days.<br /><br />The discussion notes that these findings align with prior research showing frequent insulin prescribing errors and clinical inertia in diabetes management. The authors propose system-based solutions, including a comprehensive diabetes discharge order set, embedded clinical decision support, hard stops to prevent missing supplies, redesigned discharge instructions, automatic medication reconciliation, and standardized patient education. They plan to repeat the survey and chart review after implementing these interventions.

Asset Subtitle

Elizabeth Miles

Meta Tag

Author List Claire Schmitz, Elizabeth Miles, Jana L. Wardian, Melissa McKnight, Preethi Polavarapu, Valerie Shostrom

Category Research

Concept Insulin

Concept Discharge Prescribing

Concept Diabetes Mellitus

Concept Discharge Instruction

Concept Hemoglobin A1c

Distinguished Non-Finalist

Presenter Organization Unmc

Presenting Author Elizabeth Miles

Track Quality Improvement

Keywords

insulin discharge

diabetes management

hospital discharge

prescribing errors

high-risk medication

older adults

HbA1c

medication reconciliation

clinical decision support

readmission

Insulin

Discharge Prescribing

Diabetes Mellitus

Discharge Instruction

Hemoglobin A1c