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An efficiency evaluation of protocols for tight glycemic control in intensive care units.
Am J Crit Care. 2007 Nov; 16(6):589-98.AJ

Abstract

BACKGROUND

The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals.

OBJECTIVES

To evaluate the efficiency of protocols for tight glycemic control used in intensive care units.

METHODS

Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses.

RESULTS

Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason.

CONCLUSIONS

Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.

Authors+Show Affiliations

Department of Pharmacy Practice, Creighton University Medical Center, Omaha, Nebraska 68178, USA. malesker@creighton.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17962503

Citation

Malesker, Mark A., et al. "An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units." American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses, vol. 16, no. 6, 2007, pp. 589-98.
Malesker MA, Foral PA, McPhillips AC, et al. An efficiency evaluation of protocols for tight glycemic control in intensive care units. Am J Crit Care. 2007;16(6):589-98.
Malesker, M. A., Foral, P. A., McPhillips, A. C., Christensen, K. J., Chang, J. A., & Hilleman, D. E. (2007). An efficiency evaluation of protocols for tight glycemic control in intensive care units. American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses, 16(6), 589-98.
Malesker MA, et al. An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units. Am J Crit Care. 2007;16(6):589-98. PubMed PMID: 17962503.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An efficiency evaluation of protocols for tight glycemic control in intensive care units. AU - Malesker,Mark A, AU - Foral,Pamela A, AU - McPhillips,Ann C, AU - Christensen,Keith J, AU - Chang,Julie A, AU - Hilleman,Daniel E, PY - 2007/10/27/pubmed PY - 2008/3/12/medline PY - 2007/10/27/entrez SP - 589 EP - 98 JF - American journal of critical care : an official publication, American Association of Critical-Care Nurses JO - Am J Crit Care VL - 16 IS - 6 N2 - BACKGROUND: The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. OBJECTIVES: To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. METHODS: Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. RESULTS: Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. CONCLUSIONS: Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed. SN - 1062-3264 UR - https://www.unboundmedicine.com/medline/citation/17962503/An_efficiency_evaluation_of_protocols_for_tight_glycemic_control_in_intensive_care_units_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=17962503.ui DB - PRIME DP - Unbound Medicine ER -