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Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit.
Crit Care Nurse. 2011 Dec; 31(6):27-35.CC

Abstract

BACKGROUND

Recent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units.

OBJECTIVE

To evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit.

METHODS

A nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion.

RESULTS

Ninety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P<.001) were within the target glucose range (110-149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose <70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P<.001).

CONCLUSIONS

Implementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia.

Links

Publisher Full Text

Authors+Show Affiliations

Khalaila R
Medical ICU, Hadassah–Hebrew University Medical Center, P. O. Box 91120, Jerusalem, Israel. rabeik@hotmail.com
Libersky E
No affiliation info available
Catz D
No affiliation info available
Pomerantsev E
No affiliation info available
Bayya A
No affiliation info available
Linton DM
No affiliation info available
Sviri S
No affiliation info available

MeSH

AgedAged, 80 and overBlood GlucoseCase-Control StudiesClinical ProtocolsCritical CareFemaleFollow-Up StudiesHumansHypoglycemic AgentsInfusions, IntravenousInsulinIntensive Care UnitsMaleMiddle AgedNursing Evaluation ResearchNursing Methodology ResearchPractice Patterns, Nurses'Prospective StudiesRetrospective StudiesTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22135329

Citation

Khalaila, Rabia, et al. "Nurse-led Implementation of a Safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit." Critical Care Nurse, vol. 31, no. 6, 2011, pp. 27-35.
Khalaila R, Libersky E, Catz D, et al. Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit. Crit Care Nurse. 2011;31(6):27-35.
Khalaila, R., Libersky, E., Catz, D., Pomerantsev, E., Bayya, A., Linton, D. M., & Sviri, S. (2011). Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit. Critical Care Nurse, 31(6), 27-35. https://doi.org/10.4037/ccn2011934
Khalaila R, et al. Nurse-led Implementation of a Safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit. Crit Care Nurse. 2011;31(6):27-35. PubMed PMID: 22135329.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit. AU - Khalaila,Rabia, AU - Libersky,Eugene, AU - Catz,Dina, AU - Pomerantsev,Elina, AU - Bayya,Abed, AU - Linton,David M, AU - Sviri,Sigal, PY - 2011/12/3/entrez PY - 2011/12/3/pubmed PY - 2012/4/27/medline SP - 27 EP - 35 JF - Critical care nurse JO - Crit Care Nurse VL - 31 IS - 6 N2 - BACKGROUND: Recent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units. OBJECTIVE: To evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit. METHODS: A nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion. RESULTS: Ninety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P<.001) were within the target glucose range (110-149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose <70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P<.001). CONCLUSIONS: Implementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia. SN - 1940-8250 UR - https://www.unboundmedicine.com/medline/citation/22135329/Nurse_led_implementation_of_a_safe_and_effective_intravenous_insulin_protocol_in_a_medical_intensive_care_unit_ L2 - https://aacnjournals.org/ccnonline/article-lookup/doi/10.4037/ccn2011934 DB - PRIME DP - Unbound Medicine ER -