674-P: Glycemic Management Practice Guideline Combined with a Multidisciplinary Champion Team Approach Increased the Use of Basal Bolus Insulin Regimen and Reduced the Use of Sliding Scale Insulin

Basal-bolus insulin (BBI) therapy is recommended for treatment of hyperglycemia in the inpatient setting, but many patients still receive sliding scale insulin (SSI) that has been shown to be less effective. To evaluate the transition from insulin drip to subcutaneous insulin therapy we performed a retrospective chart review spanning four months in the cardiothoracic intensive care unit (CTICU) at our institution. Of the patients in the unit who were transitioned from insulin drip, 84% (n=63) were transitioned to sliding scale insulin, while only 16% (n=12) were transitioned to basal bolus insulin therapy. Of those patients treated with basal bolus insulin, 33% (n=4) had a delay in basal insulin administration, while 17% (n=2) of patients experienced interrupted basal insulin therapy. In order to increase the use of basal bolus insulin and reduce the use of sliding scale, we developed a glycemic practice guideline which focused on when and how to transition from insulin drip to basal bolus insulin therapy. We launched a multidisciplinary champion team who assisted with the implementation of the guideline in the CTICU. After implementing the guideline for one year, we found the use of basal bolus therapy increased from 16% (n=12) to 68% (n=50), and use of sliding scale decreased from 84% (n=63) to 22% (n=16), (p=0.008). Furthermore, patients who were treated with basal bolus insulin therapy had less delay and interruption of basal insulin by 21% and 7%, respectively, although the difference was not statistically significant (p=0.10). Additional studies are necessary to determine whether our guideline, combined with a multidisciplinary team approach, would affect clinical outcomes.