Background: Prescribing insulin pens without needles during hospital discharge was common in our hospital system. We assessed the impact of quality initiatives and prescribing guidance on the prevalence of patients discharged on insulin pens with and without an associated prescription for pen needles.

Methods: We retrospectively collected data from Emory-healthcare hospitals, from January 2015-May 2018 (pre-intervention period) , then up to October 2021 (post-intervention period) . Adults (>18 years) with at least one prescription for insulin pens were included. As part of an updated discharge plan, an automated EMR alert was linked to orders for insulin pens without needles, aiming to reduce prescription errors at discharge. We compared the proportion of patients discharged on insulin pens with/without an associated pen needles prescription during the pre and post-intervention periods. We used interrupted time-series analysis (ITS) to examine the intervention impact on 30- and 90-day hospital readmissions.

Result: Among 7654 patients discharged with insulin pens (median age 56 years, IQR 45-66) , 50.4% were Females, 65.5% were African-Americans, and mean HbA1c was 10.9±2.9%. After the intervention, the proportion of patients without an associated prescription for pen needles decreased compared to the pre-intervention (mean decrease 31.3%, 95% CI: 31.2%, 31.3%) . Inpatient diabetes education consult was more common among those with an associated pen needles prescription during the pre- (61.4% vs. 33.7%) and post-intervention period (64.7% vs. 33%) , compared to those without it, p<0.001. After the intervention, there was a significant improvement in 90-days hospital readmission rates (-0.99% per quarter; P<0.005) , whereas the change in slope was not significant for 30-day hospital readmission rates.

Conclusion: Our initiative significantly decreased the prevalence of missing pen needles prescriptions by ∼30%, and was associated with less 90-days hospital readmission rates.

Disclosure

B. Moazzami: None. M. Wald: None. R. Jagannathan: None. R. J. Galindo: Advisory Panel; Sanofi, WW International, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk. P. Hwang: None. S. Ashraf: None. A. Van prooyen: None. H. F. Shabbir: None. M. Klimenko: None. E. Brechtelsbauer: None. E. Molitch-hou: None. M. A. Hinds: None.

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