Elsevier

Endocrine Practice

Volume 15, Issue 1, January–February 2009, Pages 24-29
Endocrine Practice

Original Article
Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy can be Safely Used in the Hospital in Select Patients

https://doi.org/10.4158/EP.15.1.24Get rights and content

ABSTRACT

Objective

To analyze data on inpatient insulin pump use and examine staff compliance with hospital procedures, glycemic control, and safety.

Methods

We conducted a retrospective review of charts and bedside glucose data for patients who had been receiving outpatient insulin pump therapy and were admitted to our teaching hospital between November 1, 2005, and February 8, 2008.

Results

During the study period, there were 50 hospitalizations involving 35 patients who had been receiving outpatient insulin pump therapy. The mean age and duration of diabetes of the 35 patients was 55 years and 32 years, respectively. Sixty-six percent were women, and 91% had type 1 diabetes. Patients in 31 of the hospitalizations (62%) were deemed candidates for continued insulin pump therapy during their stay. Of the 31 hospitalizations, 80% had the presence of the pump documented at admission; 100% had an admission glucose value; 77% had documentation of signed patient consent; 81% had evidence of completed preprinted insulin pump orders; 77% received an endocrine consultation; and 68% had a completed bedside flow sheet. Patients continuing insulin pump therapy had mean bedside glucose levels similar to those whose pump therapy was discontinued (P = .11); however, the proportion of hypoglycemic events was lower among insulin pump users (P < .01) than among nonusers.

Conclusions

Insulin pump therapy is safe for select inpatients. Overall, staff compliance with procedures was high, although we identified areas for improvement. Continued study is needed on the effectiveness of insulin pump therapy in controlling inpatient hyperglycemia. (Endocr Pract. 2009;15:24-29)

Section snippets

INTRODUCTION

Outpatient continuous subcutaneous insulin infusion (CSII), commonly referred to as insulin pump therapy, delivers intensive insulin treatment for optimal glucose control. As the use of CSII increases, health care providers in the hospital may more frequently face the issue of how best to manage the care of patients who are using CSII. Many individuals on CSII therapy are educated extensively in the self-management of diabetes mellitus and can invest considerable time and money in the

Description of Facility

Our tertiary care academic medical center is a 200-plus–bed facility in metropolitan Phoenix, Arizona. All general medical and surgical specialties for adult patients are represented; pediatric care and obstetric care are not provided. The hospital also has a level II trauma center and an inpatient rehabilitation unit. Inpatient care is provided by various types of practitioners, including resident physicians, students in allied health and medical school, physician assistants, nurse

Patient Characteristics

We identified a total of 50 hospital admissions that occurred between November 1, 2005, and February 8, 2008, for 35 individual patients who had been receiving outpatient insulin pump therapy. Eight unique patients had a total of 23 admissions. Twenty-one patients were receiving their outpatient diabetes care outside of our health system. The mean age of the 35 patients was 55 years; the mean diabetes duration was 32 years. The mean selfreported duration of CSII therapy was 4 years. All

DISCUSSION

Patients who receive CSII therapy are educated intensively on diabetes self-management and invest considerable time in mastering the technology. We have often encountered situations in which patients on outpatient CSII therapy are eager to continue this treatment while hospitalized. However, there are many different insulin pump models available, and given the infrequency of seeing patients who use an insulin pump, practitioners in hospitals cannot be expected to gain expertise with the

CONCLUSION

We conclude that CSII therapy can be safely continued in a hospital setting in select patients. Overall implementation of our inpatient insulin pump policy has been successful. The necessary documentation and procedures are being accomplished for most patients, although improvement is needed to reach 100% compliance in performance of all components. Our analysis also provided us with ongoing data about the characteristics of the inpatient population that receives CSII. Determining whether CSII

DISCLOSURE

The authors have no conflicts of interest to disclose.

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