Implementation of a novel insulin infusion calculator in the electronic health record medication administration record: Assessing efficacy and safety in intensive care unit patients

Abstract Introduction Intravenous insulin infusions are recommended for control of hyperglycemia in critically ill patients. Institutions have adopted nurse‐driven titration protocols for management of infusions; however, optimal integration within electronic health records (EHRs) has lagged. Data is lacking regarding clinical pharmacist interventions in standardizing and implementing decision support with electronic nomograms. Methods This multicenter cohort study aimed to evaluate the efficacy and safety of implementing an EHR medication administration record (MAR) calculator for insulin infusion in 29 hospital intensive care units (ICUs). Outcomes were evaluated before and after implementation of the EHR MAR calculator (April 12–June 5, 2023; implementation on May 9, 2023). The primary efficacy outcome was the proportion of blood glucose values within a target range of 140–179 mg/dL. Secondary outcomes included the proportions of hypoglycemic and hyperglycemic glucose values. Results A total of 206 patients were included: 109 in the pre‐group and 97 in the post‐group. More patients in the pre‐group received corticosteroids (40.4% vs. 22.7%). The EHR MAR calculator implementation showed a significant increase in glucose values within the target range (35.5% post‐implementation vs. 31.0% pre‐implementation, p = 0.02). There were no significant differences in the occurrence of hypoglycemic events, but the rate of hyperglycemia decreased (549 [43.7%] post‐implementation, 601 [48.6%] pre‐implementation, p = 0.02). Discussion This is the first study describing implementation of an integrated MAR calculator that automatically imports blood glucose results used for calculations in the MAR and does not rely on manual input by the nurse. The study demonstrated the benefits of transitioning from a paper‐based nomogram to an EHR MAR calculator for insulin infusion management in critically ill patients in improving time in target range and reducing the proportion of hyperglycemic values. Pharmacists provided standardization, validation, education, and assisted with implementation to streamline transitions of care, monitoring methods, and drug‐laboratory interaction concerns.