# Implementation of a Best Practice Advisory to alert inpatient providers of necessary discharge prescriptions for insulin and supplies for patients with diabetes

## TL;DR

A digital alert system in hospitals improved the accuracy of diabetes prescriptions and supplies at discharge, enhancing patient safety and care.

## Contribution

A low-cost, scalable digital intervention using a Best Practice Advisory in the EMR improved diabetes discharge prescriptions.

## Key findings

- 99% of patients received the correct insulin type and formulation at discharge.
- 88% of patients received all recommended diabetes supplies at discharge.
- Only 1% of patients contacted the hospital post-discharge for additional supplies.

## Abstract

•An EMR Best Practice Advisory enhanced diabetes prescription accuracy on discharge.•99% of patients got correct insulin type and formulation (pen or vial) of insulin.•88% of patients received all recommended diabetes supplies at discharge.•Digital intervention is low-cost, sustainable, and scalable for diabetes care.

An EMR Best Practice Advisory enhanced diabetes prescription accuracy on discharge.

99% of patients got correct insulin type and formulation (pen or vial) of insulin.

88% of patients received all recommended diabetes supplies at discharge.

Digital intervention is low-cost, sustainable, and scalable for diabetes care.

Medication discrepancies and omissions at hospital discharge are a common, preventable source of harm for patients with diabetes. Ensuring accurate prescriptions for insulin and diabetes supplies is critical for safe transitions of care. We aimed to evaluate the impact of a Best Practice Advisory (BPA) integrated into the electronic medical record (EMR) on the accuracy of diabetes-related discharge prescriptions.

This quality improvement initiative was implemented across seven hospitals within a large health system. The BPA was triggered in the EMR discharge navigator for patients evaluated by a Diabetes Care and Education Specialist (DCES), prompting providers to review and order recommended diabetes medications and supplies. BPA utilization data were collected from February to December 2022. A retrospective chart review of 100 consecutive eligible patients discharged in December 2022 seen by DCES was assessed for prescription accuracy and supply provision.

The BPA was triggered 6,714 times for 2,266 patient encounters over 11 months. Among 100 reviewed patients (mean age 57 years, 58 % male, 76 % type 2 diabetes), insulin prescription accuracy at discharge was 99 %, and 88 % received all recommended diabetes supplies. Only 1 % of patients contacted the hospital post discharge for additional supplies, suggesting most omissions were clinically appropriate.

Integration of a BPA into the EMR significantly improved the accuracy and completeness of diabetes-related discharge prescriptions. This low-cost, sustainable digital intervention enhances patient safety and care quality, and represents a scalable model for improving discharge practices in inpatient settings.