Assessing the Prevalence of Inappropriate Insulin Prescribing at Hospital Discharge Darci Conklin, Jack Handshaw AdventHealth Celebration – Celebration, FL
Background/Purpose: To review current prescribing trends to assess whether patients with diabetes are receiving appropriate insulin therapy at hospital discharge.
Methodology: Retrospective chart review of patients prescribed insulin at discharge from Advent Health Celebration, spanning from March 1st, 2025, to July 31st, 2025. The primary endpoint of the study was a composite of patients deemed to have inappropriate insulin prescriptions at discharge; defined as having at least one of the following: Patients prescribed duplicate insulin therapy, patients prescribed a regimen of correctional insulin only, patients prescribed an insulin prescription with inappropriate instructions, patients not prescribed appropriate insulin administration devices such as pen needles or insulin syringes, patients prescribed insulin when previously controlled on non-insulin antidiabetic medications prior to admission or patients who did not require insulin therapy as per the 2026 ADA Standards of Care in Diabetes guidelines. Secondary endpoints included incidence of each component of the primary composite endpoint, incidence of 30-day and 90-day re-admission due to a diabetes-related cause, patients co-prescribed glucagon, and patients co-prescribed testing supplies. Patients were included in this review if they were aged 18 years or older, had a discharge disposition of self-care or home health, were diagnosed with diabetes prior to or during the reviewed admission, and had a recorded A1c within the 6 months prior to discharge.
Results: A total of 198 patients were initially extracted for retrospective review; however, 39 patients were excluded, leaving 158 patient encounters eligible for analysis. Of the 158 encounters, 70 encounters were found to have inappropriate insulin prescriptions at discharge (70/158, 44.3%). No patients reviewed were prescribed glucagon at discharge, and only 57 patient encounters had patients prescribed testing supplies at discharge (57/158, 36.08%). A total of 21 patients were readmitted within 30 days of discharge (21/158, 13.29%), with 7 of these 21 patients (33.33%) deemed to have an inappropriate insulin prescription at discharge. Similarly, a total of 30 patients were readmitted within 90 days of discharge (30/158, 18.99%), with 10 patients (33.33%) discharged with an inappropriate insulin prescription.
Conclusions: Nearly half of patient encounters reviewed were deemed to have improper prescribing of insulin or associated supplies at hospital discharge. The most common insulin prescription errors seen were prescriptions with incorrect sliding scale instructions and patients not prescribed appropriate administration devices. Readmissions at 30 and 90 days were not seen to be associated with receiving inappropriate insulin prescriptions at discharge. Encounters where patients received a prescription for testing supplies or glucagon were also substantially low to non-existent. Based on the results seen, there is an opportunity for targeted education of prescribing physicians and inpatient clinical staff on insulin at discharge. These results also highlight the importance of pharmacist review in the transitions of care space for management of diabetes upon discharge and for the facilitation of close outpatient follow-up.
