Evaluation of a Standardized Sliding Scale Insulin Preprinted Order
Bibliographic record
Abstract
Background: Poor glycemic control is associated with negative outcomes in hospitalized patients with diabetes, both during and beyond their hospital stay. Despite its limitations, adjunct sliding scale insulin (SSI) is often prescribed to manage glucose levels, but the regimens are subject to wide variability and may contribute to medication error. Objective: To evaluate diabetic patients' glycemic control and staff acceptability following development and implementation of an SSI preprinted order (PPO). Methods: A retrospective chart review of diabetic patients admitted to the adult internal medicine service at a major Canadian teaching hospital was conducted. A convenience sample of patients who received SSI before (n = 60) and after (n = 60) PPO implementation was evaluated for episodes and management of hypo- and hyperglycemia. A survey also was conducted to determine staff perspectives regarding SSI PPO use. Results: Thirty-five SSI regimens were identified among the 60 patients in the pre-PPO group. Although no significant difference in the incidence of hypoglycemia was found between groups, more hyperglycemia episodes occurred in the post-PPO group. Glycemic control was poor regardless of the SSI prescribing strategy employed; only half of the measurements in either group were within a 72–198 mg/dL target range. One-third of medical students reported receiving no prior teaching for devising an SSI regimen. Both medical and nursing staff reported increased clarity and ease in administering SSI with use of a PPO. Half of the respondents believed that the potential for medication error was diminished. Conclusions: A PPO decreased variability in SSI prescribing but did not improve glycemic control in diabetic patients admitted to internal medicine. Revisions to our documents have been made to address hyperglycemia events and appropriate SSI use to further promote patient safety through standardized prescribing.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".