Endocrine Abstracts

Background: Insulin is a high-risk medicine that was involved in just under 20% of all medication safety events causing harm following a local audit that reviewed data over a 2.5 year period. Insulin was one of the only licensed medicine remaining that was managed via a paper process in inpatient areas at St James’s Hospital as it was excluded from the initial implementation of electronic medicines management processes due to the significant amount of additional design features needed to safely manage this high-risk drug. Medication safety data indicated the separate paper process created clinical risk. Expert opinion, and the literature suggested migration to a digital solution would deliver safety, effectiveness and efficiency benefits.

Aims/objectives: Design and implement a custom digital solution in the EPR for insulin management in collaboration with multiple clinical disciplines.

Methods: An agile, iterative design and collaborative approach was adopted throughout the 6-month project period. Over 50 workshops and meetings with stakeholders in informatics, endocrinology, medicine, nursing, pharmacy and operations were organised to identify requirements, make design decisions and plan the implementation.

Results: The custom insulin management solution design and build included 11 clinical decision support tools and 10 prescribing plans with additional configuration to support prescribing, administration and monitoring/review in patients with DKA/ HHS. A usability score of 81% was calculated following an assessment of perceived usability of the insulin solution following implementation across the nursing, pharmacy, clinician, clinical nutrition disciplines. There have been no reported insulin-related medication safety events causing harm since implementation in March 2023.

Conclusion : The critical success factors to the safe and effective custom insulin management solution implementation project include the clinical collaboration, multi-disciplinary input. Project success has been demonstrated by the high usability score, assessed using a validated usability tool and the lack of events causing harm.