(1294) Impact of Reduced Time to Basal SQ Insulin Administration in DKA Patients: A Pilot

Introduction: Transitioning from an intravenous (IV) insulin infusion to a subcutaneous (SQ) basal/bolus insulin regimen is a standard step of recovery from diabetic ketoacidosis (DKA), regardless of etiology. This transition occurs once laboratory values confirm that ketone production has ceased, and the anion gap has closed.

Description: Cleveland Clinic Hillcrest Hospital is a 500-bed community hub hospital in the Cleveland Clinic Health System with a high census of DKA patients in the intensive care unit (ICU). The basal insulin on formulary is insulin glargine, dispensed as Lantus® SQ pens. Historically, insulin glargine pens were dispensed from the centralized pharmacy from a carousel inventory system. These pens cannot be tubed to the nursing floor via the pneumatic tube system due to risk of denaturing the insulin, thus limiting delivery of the pens to the hourly medication delivery rounds. Significant delay in transition from IV insulin infusions to SQ insulin administration was historically noted due to the turnaround time from the order to delivery of the insulin pen. The average turnaround time from SQ insulin order to administration was approximately 125 minutes. Collaboration between the medical, pharmacy, and nursing teams in the ICU led to a pilot plan where Lantus® SQ pens were stocked in the automated dispensing cabinet (ADC) located in the ICU, potentially leading to a decreased turnaround time from order entry to administration.

Discussion: Medication delivery turnaround time is often a limitation to timely medication administration. Stocking medications in ADCs reduces turnaround time. Average turnaround time for SQ basal insulin decreased from just over 2 hours (125 minutes) to an average of 19.5 minutes. This pilot required education of nurses to emphasize safe medication practices, including dating of the pens, labeling of patient-specific pens, and appropriate storage of the pens once removed from the ADC. Provider and nurse satisfaction with turnaround time of SQ insulin administration has increased. Stocking insulin glargine SQ pens in ICU ADCs permitted nurses to administer basal insulin significantly sooner than previous medication delivery processes, leading to reduced time on the insulin infusion and a potential decrease in ICU length of stay for DKA patients.