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Nurse- vs nomogram-directed glucose control in a cardiovascular intensive care unit.
Am J Crit Care. 2012 Jul; 21(4):270-8.AJ

Abstract

BACKGROUND

Paper-based nomograms are reasonably effective for achieving glycemic control but have low adherence and are less adaptive than nurses' judgment.

OBJECTIVE

To compare efficacy (glucose control) and safety (hypoglycemia) achieved by use of a paper nomogram versus nurses' judgment.

METHODS

Prospective, randomized, open-label, crossover trial in an intensive care unit in postoperative patients with glucose concentrations greater than 8 mmol/L. Consenting nurses with at least 1 year of experience were randomized to use either their judgment or a validated paper-based nomogram for glucose control. After completion of 2 study shifts, the nurses used the alternative method for the next 2 study shifts. Glucose target level and safety and efficacy boundaries were the same for both methods. The primary end point was area under glucose time curve per hour.

RESULTS

Thirty-four nurses contributed 95 shifts of data (44 nomogram-directed, 51 nurse-directed). Adherence to the nomogram was higher in the nomogram group than hypothetical adherence in the nurse-directed group for correct adjustments in insulin infusion (70% vs 37%; P < .001) and glucose checks (58% vs 43%; P = .008). The primary end point did not differ between the 2 groups (mean, 9.0 mmol/L; SD, 3.5 vs mean, 8.3 mmol/L; SD, 2.1; P = .08). Glucose variability, amount of time patients were hypoglycemic or hyperglycemic, and number of glucose checks performed were similar in the 2 groups.

CONCLUSIONS

In an intensive care unit where nurses generally accepted the need for tight glucose control, nurse-directed control was as effective and as safe as nomogram-based control.

Authors+Show Affiliations

Pharmacy Department, Critical Care Department at St Michael's Hospital, Toronto, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22751370

Citation

Chant, Clarence, et al. "Nurse- Vs Nomogram-directed Glucose Control in a Cardiovascular Intensive Care Unit." American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses, vol. 21, no. 4, 2012, pp. 270-8.
Chant C, Mustard M, Thorpe KE, et al. Nurse- vs nomogram-directed glucose control in a cardiovascular intensive care unit. Am J Crit Care. 2012;21(4):270-8.
Chant, C., Mustard, M., Thorpe, K. E., & Friedrich, J. O. (2012). Nurse- vs nomogram-directed glucose control in a cardiovascular intensive care unit. American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses, 21(4), 270-8. https://doi.org/10.4037/ajcc2012713
Chant C, et al. Nurse- Vs Nomogram-directed Glucose Control in a Cardiovascular Intensive Care Unit. Am J Crit Care. 2012;21(4):270-8. PubMed PMID: 22751370.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nurse- vs nomogram-directed glucose control in a cardiovascular intensive care unit. AU - Chant,Clarence, AU - Mustard,Mary, AU - Thorpe,Kevin E, AU - Friedrich,Jan O, PY - 2012/7/4/entrez PY - 2012/7/4/pubmed PY - 2012/11/8/medline SP - 270 EP - 8 JF - American journal of critical care : an official publication, American Association of Critical-Care Nurses JO - Am J Crit Care VL - 21 IS - 4 N2 - BACKGROUND: Paper-based nomograms are reasonably effective for achieving glycemic control but have low adherence and are less adaptive than nurses' judgment. OBJECTIVE: To compare efficacy (glucose control) and safety (hypoglycemia) achieved by use of a paper nomogram versus nurses' judgment. METHODS: Prospective, randomized, open-label, crossover trial in an intensive care unit in postoperative patients with glucose concentrations greater than 8 mmol/L. Consenting nurses with at least 1 year of experience were randomized to use either their judgment or a validated paper-based nomogram for glucose control. After completion of 2 study shifts, the nurses used the alternative method for the next 2 study shifts. Glucose target level and safety and efficacy boundaries were the same for both methods. The primary end point was area under glucose time curve per hour. RESULTS: Thirty-four nurses contributed 95 shifts of data (44 nomogram-directed, 51 nurse-directed). Adherence to the nomogram was higher in the nomogram group than hypothetical adherence in the nurse-directed group for correct adjustments in insulin infusion (70% vs 37%; P < .001) and glucose checks (58% vs 43%; P = .008). The primary end point did not differ between the 2 groups (mean, 9.0 mmol/L; SD, 3.5 vs mean, 8.3 mmol/L; SD, 2.1; P = .08). Glucose variability, amount of time patients were hypoglycemic or hyperglycemic, and number of glucose checks performed were similar in the 2 groups. CONCLUSIONS: In an intensive care unit where nurses generally accepted the need for tight glucose control, nurse-directed control was as effective and as safe as nomogram-based control. SN - 1937-710X UR - https://www.unboundmedicine.com/medline/citation/22751370/Nurse__vs_nomogram_directed_glucose_control_in_a_cardiovascular_intensive_care_unit_ L2 - https://aacnjournals.org/ajcconline/article-lookup/doi/10.4037/ajcc2012713 DB - PRIME DP - Unbound Medicine ER -