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Q&A

Obstetric Quality and Safety

Poster Session 3

(764) Optimizing Glucose Control and User Satisfaction with a Diabetes in Pregnancy Order Set Algorithm

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Jenny Y. Mei, MD (she/her/hers)

    Maternal-Fetal Medicine Fellow
    University of California, Los Angeles
    Los Angeles, CA, United States

    • Coauthor(s)

  • TN

    Tina A. Nguyen, MD

    Associate Professor
    David Geffen School of Medicine, University of California Los Angeles
    Los Angeles, CA, United States

Objective:

Correctional insulin is frequently ordered for pregnant patients on Labor and Delivery however preexisting insulin order sets are designed for non-pregnant patients. We aimed to create an obstetrics specific insulin order set in our electronic health record to improve efficiency, standardization, and user satisfaction. 

 

Study Design:

With joint collaboration between maternal-fetal medicine, endocrinology, and nursing, we created a standardized insulin order set for use in pregnant patients with antepartum, intrapartum, and postpartum orders for each phase of care. A 20-item REDCAP survey was administered to MD and RN providers prior to and after implementation. Users rated on a Likert scale various statements assessing user satisfaction across 4 domains: usability of orders, communication between providers, clarity of orders, and efficiency of use.  Chi-square or independent samples t-test were used to compare groups as appropriate. The study was deemed IRB exempt #22-000102.

Results:

Total 59 providers completed the survey prior to implementation of the order set and 24 completed it up to 12 months post-implementation. Demographics of survey participants did not vary between groups. After implementation of the new order set, there was significant improvement in perceived usability of the orders interface, including adaptability, clarity, and standardization of instructions across patients (p< 0.001). Providers reported decreased rates of miscommunication, incorrect orders, avoidable mistakes, and safety concerns (p< 0.001). Providers felt improved clarity of orders including blood glucose checks and insulin coverage (p< 0.001). There was also reported improvement in efficiency, with decreased amounts of time spent on orders and overall increased satisfaction with the orders interface (p< 0.001). 

Conclusion:

Implementation of a standardized obstetric specific insulin order set can significantly improve provider satisfaction on Labor and Delivery, helping improve usability, communication, and efficiency.