(280) Effect of Pharmacist Expanded Scope of Practice on Diabetic Ketoacidosis Transition Times

Introduction: At the academic campus of our institution, emergency medicine pharmacists (EMP) practice under an expanded scope of practice (ESOP) for patients in the emergency department (ED), as well as ICU patients boarding in the ED. EMP are an integral part of initial diabetic ketoacidosis (DKA) management and the transition period at DKA resolution. Under the ESOP, EM or ICU pharmacists can transition a patient from an insulin infusion to subcutaneous insulin when the patient is stable and acidosis has resolved. This study will assess the impact of an ESOP on time from DKA resolution to transition by comparing the academic hospital to outlying community hospitals in our system that have not yet implemented an ESOP.

Methods: This is a single system, multi-center, retrospective, cohort study of patients admitted to any adult hospital between October 2022 and December 2023 diagnosed with DKA and initiated on an insulin infusion. Patients who met study inclusion criteria were divided in a 1:2 fashion to the ESOP group (50) and the non-ESOP group (100).

Results: There were no significant differences in baseline characteristics (age, gender, initial CO2) other than more frequent sodium bicarbonate administration in the non-expanded scope group (14% vs 26%). Transition off the DKA protocol was done via scope of practice in 48% of patients in the ESOP group. For the primary outcome, time from DKA resolution to transition was faster for the ESOP group (2.8 v 7.6 hours, p< 0.001). This group also had a shorter duration of insulin infusion (13 v 17 hours, p< 0.001). Interestingly, this group had a longer ED length of stay (17.4 v 6.8 hours, p<.0001) and more patients remaining in the ED for the duration of the DKA protocol (60% v 10%, p< 0.001). ICU length of stay (LOS) was shorter for the ESOP group (18 vs 24 hours, p< 0.001). The ESOP group had fewer hypoglycemic episodes (2% v 14%, p=0.021).

Conclusions: The utilization of an ESOP for EMP resulted in reduced time from DKA resolution to transition, reduced ICU LOS, reduced insulin infusion times, and fewer hypoglycemic episodes despite longer ED LOS. These results reinforce the benefit of EM pharmacy services particularly in EDs with prolonged ICU boarding times.