Digital diabetes care an Australian first

Professor Stephen Twigg
14 November 2016

For the first time in Australia, medical, nursing and pharmacy staff will have access to a consolidated ‘e-view’ of their diabetic patients’ insulin therapy, thanks to an exciting new initiative of Sydney Local Health District and eHealth NSW.

The Insulin MPage, a customised view on the electronic medical record (eMR), is rolling out as part of eHealth NSW’s electronic medication management (eMeds) program. It is anticipated to go live in a pilot ward at Concord Repatriation General Hospital and is planned to form part of the eMeds implementation at Royal Prince Alfred Hospital.

“NSW Health has worked to improve the format of these paper-based charts over the past five or more years (and) the electronic glucose and insulin customised view provides a significant opportunity to further enhance patient safety,” said Professor Stephen Twigg, Head of the Department of Endocrinology at Royal Prince Alfred Hospital, and a Professor at the University of Sydney.

“The Insulin MPage, which is now in advanced development, is a screen within eMeds that combines the observation of trends in blood glucose readings with the recording of administered insulin therapy. The MPage enhances trend interpretations and insulin prescribing by dynamically displaying these two important sets of data together and in colour-coded, user-friendly formats. Having all of that information on one ‘e-page’ is a first in Australia.”

“Clinicians also have decision support to administer Triple B (basal-bolus booster) protocol for insulin therapy, as well as avenues for minimising insulin ‘stacking’ by providing an alert to aid prescribing a more usual frequency of subcutaneous insulin injections.”

For millions of people living with diabetes, being admitted to hospital involves additional risk and worry. When they are stressed or sick, blood glucose levels often become unstable. If glucose levels drop below a certain level, causing hypoglycaemia, this can lead to a patient feeling unwell, sweating, shaking and, at the extreme, losing consciousness and experiencing seizure, heart attack or stroke. Conversely, if glucose levels become too elevated, a patient may become dehydrated, lose vision or even enter a coma.

Professor Twigg explained: “In Australia, it’s not uncommon for about one-fifth or more of an acute care hospital’s patients to have diabetes. Unstable blood glucose levels are a common concern as they can make a person with diabetes feel unwell, when they are already sick and stressed with the illness that has brought them into hospital.”

“Hospitals are tasked with the challenge of prescribing and administering insulin therapy for patients to help ensure their blood glucose levels remain within a safe range. This around-the-clock effort is a major challenge globally: in Australia, insulin administration and prescription consistently rates as a top cause of medication-related adverse outcomes or incidents in hospitals,” said Professor Twigg.

When prescribing and documenting administration of insulin, clinicians have traditionally used paper processes to monitor observations, track administration and inform prescription decision-making.

“The benefits of the enhanced decision support provided by the Insulin MPage are clear: accurate insulin prescriptions and safe glucose outcomes for patients with diabetes in public hospitals who are often very sick after being admitted for other reasons, or who are undertaking major surgical procedures,” said Professor Twigg, who is a past president of the Australian Diabetes Society, the peak scientific and health professional body for diabetes in Australia, and the current Co-Chair of the ACI Endocrine Network.

“The past year has seen great progress on the path to realising these benefits as we overcome the challenges associated with changing how our hospital cares for patients with the safe delivery of medications.”

“At first, our attention was focused on helping to configure a customised view in the eMR to suit clinical requirements. As we move closer to roll-out, our collaborative focus with eHealth NSW is increasingly on providing suitable training and development programs to support our clinicians in learning more about the Insulin MPage and how to use it best in patient care. The design consultation process for the Insulin MPage journey provides a great framework for other high-risk and complex medication designs. The project has engaged nursing staff from various specialties, clinical consultants and junior medical staff, pharmacists, a series of major teaching hospitals, the Agency for Clinical Innovation’s Endocrine Working Party, the software vendor and the team at eHealth NSW – it’s been a real collaborative effort.”

View of the Insulin Mpage screen
View of the Insulin Mpage screen

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