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Evaluation of compliance with a paper-based, multiplication-factor, intravenous insulin protocol.
Ann Pharmacother. 2009 Sep; 43(9):1413-8.AP

Abstract

BACKGROUND

Hyperglycemia is common in critically ill patients and is an independent risk factor for in-hospital morbidity and mortality.

OBJECTIVE

To assess compliance with a paper-based, multiplication-factor, intravenous insulin protocol.

METHODS

A retrospective chart review was conducted in a 720-bed urban, academic medical center in Boston, Massachusetts. During a 1-month period, compliance with and the consequent safety and efficacy of the Brigham and Women's Hospital paper-based, multiplication-factor, intravenous insulin protocol was evaluated.

RESULTS

The primary endpoint of protocol compliance, defined as correct adjustment to insulin infusion rate and correct timing of bedside blood glucose concentration (BBGC) checks +/-10 minutes of prespecified BBGC check according to the Brigham and Women's Hospital Intravenous Insulin Protocol (BHIP), was 47.2%. Seventy-two patients met inclusion criteria. Appropriate adjustment of infusion rates occurred 68.2% (1206/1768) of the time. Compliance with the timing of BBGC checks was found to be the majority of protocol violations. BBGCs were monitored +/-5 minutes of indicated time per the protocol 26.2% (463/1768) of the time. Blood glucose concentration checks within extended timing of +/-10 minutes of indicated time per the protocol occurred 793 (44.8%) times. Blood glucose concentration monitoring took place greater than 20 minutes past indicated time 450 (25.5%) times. In 1768 measurements, blood glucose concentrations between 40 and 60 mg/dL occurred 23 (1.3%) times in 12 (16.7%) patients. Blood glucose concentrations 40 mg/dL or less were detected 3 (0.17%) times in 2 (2.7%) patients. None of these hypoglycemic events led to documented complications.

CONCLUSIONS

Overall, a rather low level of compliance with a paper-based, multiplication-factor, intravenous insulin protocol was observed, which warrants further investigation. Compliance rates in this evaluation were found to be similar to the rates observed in previously evaluated fixed-dose intravenous insulin protocols. Protocol noncompliance may be associated with hypo- and hyperglycemia.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Cyrus RM
Department of Pharmacy, Pharmacy Administration; L-2, Brigham and Women's Hospital, Boston, MA 02115, USA. rcyrus@partners.org
Szumita PM
No affiliation info available
Greenwood BC
No affiliation info available
Pendergrass ML
No affiliation info available

MeSH

Academic Medical CentersAdultAgedAged, 80 and overBlood GlucoseCritical CareCritical IllnessFemaleGuideline AdherenceHumansHyperglycemiaHypoglycemic AgentsInfusions, IntravenousInsulinMaleMiddle AgedPractice Guidelines as TopicRetrospective StudiesTime Factors

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19654334

Citation

Cyrus, Rachel M., et al. "Evaluation of Compliance With a Paper-based, Multiplication-factor, Intravenous Insulin Protocol." The Annals of Pharmacotherapy, vol. 43, no. 9, 2009, pp. 1413-8.
Cyrus RM, Szumita PM, Greenwood BC, et al. Evaluation of compliance with a paper-based, multiplication-factor, intravenous insulin protocol. Ann Pharmacother. 2009;43(9):1413-8.
Cyrus, R. M., Szumita, P. M., Greenwood, B. C., & Pendergrass, M. L. (2009). Evaluation of compliance with a paper-based, multiplication-factor, intravenous insulin protocol. The Annals of Pharmacotherapy, 43(9), 1413-8. https://doi.org/10.1345/aph.1M060
Cyrus RM, et al. Evaluation of Compliance With a Paper-based, Multiplication-factor, Intravenous Insulin Protocol. Ann Pharmacother. 2009;43(9):1413-8. PubMed PMID: 19654334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of compliance with a paper-based, multiplication-factor, intravenous insulin protocol. AU - Cyrus,Rachel M, AU - Szumita,Paul M, AU - Greenwood,Bonnie C, AU - Pendergrass,Merri L, Y1 - 2009/08/04/ PY - 2009/8/6/entrez PY - 2009/8/6/pubmed PY - 2009/11/3/medline SP - 1413 EP - 8 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 43 IS - 9 N2 - BACKGROUND: Hyperglycemia is common in critically ill patients and is an independent risk factor for in-hospital morbidity and mortality. OBJECTIVE: To assess compliance with a paper-based, multiplication-factor, intravenous insulin protocol. METHODS: A retrospective chart review was conducted in a 720-bed urban, academic medical center in Boston, Massachusetts. During a 1-month period, compliance with and the consequent safety and efficacy of the Brigham and Women's Hospital paper-based, multiplication-factor, intravenous insulin protocol was evaluated. RESULTS: The primary endpoint of protocol compliance, defined as correct adjustment to insulin infusion rate and correct timing of bedside blood glucose concentration (BBGC) checks +/-10 minutes of prespecified BBGC check according to the Brigham and Women's Hospital Intravenous Insulin Protocol (BHIP), was 47.2%. Seventy-two patients met inclusion criteria. Appropriate adjustment of infusion rates occurred 68.2% (1206/1768) of the time. Compliance with the timing of BBGC checks was found to be the majority of protocol violations. BBGCs were monitored +/-5 minutes of indicated time per the protocol 26.2% (463/1768) of the time. Blood glucose concentration checks within extended timing of +/-10 minutes of indicated time per the protocol occurred 793 (44.8%) times. Blood glucose concentration monitoring took place greater than 20 minutes past indicated time 450 (25.5%) times. In 1768 measurements, blood glucose concentrations between 40 and 60 mg/dL occurred 23 (1.3%) times in 12 (16.7%) patients. Blood glucose concentrations 40 mg/dL or less were detected 3 (0.17%) times in 2 (2.7%) patients. None of these hypoglycemic events led to documented complications. CONCLUSIONS: Overall, a rather low level of compliance with a paper-based, multiplication-factor, intravenous insulin protocol was observed, which warrants further investigation. Compliance rates in this evaluation were found to be similar to the rates observed in previously evaluated fixed-dose intravenous insulin protocols. Protocol noncompliance may be associated with hypo- and hyperglycemia. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/19654334/Evaluation_of_compliance_with_a_paper_based_multiplication_factor_intravenous_insulin_protocol_ DB - PRIME DP - Unbound Medicine ER -