Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit
Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit Philip A. Goldberg , MD 1 , Mark D. Siegel , MD 2 , Robert S. Sherwin , MD 1 , Joshua I. Halickman 1 , Michelle Lee , MD 1 , Valerie A. Bailey , MSN, RN 3 , Sandy L. Lee , MSN, RN 3 , James D. Dziura ,...
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| Published in: | Diabetes care Vol. 27; no. 2; pp. 461 - 467 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Alexandria, VA
American Diabetes Association
01-02-2004
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit
Philip A. Goldberg , MD 1 ,
Mark D. Siegel , MD 2 ,
Robert S. Sherwin , MD 1 ,
Joshua I. Halickman 1 ,
Michelle Lee , MD 1 ,
Valerie A. Bailey , MSN, RN 3 ,
Sandy L. Lee , MSN, RN 3 ,
James D. Dziura , PHD 4 and
Silvio E. Inzucchi , MD 1
1 Department of Internal Medicine, Section of Endocrinology, Yale New Haven Hospital, Yale University School of Medicine, New
Haven, Connecticut
2 Department of Internal Medicine, Section of Pulmonary & Critical Care, Yale New Haven Hospital, Yale University School of
Medicine, New Haven, Connecticut
3 Department of Nursing, Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
4 General Clinical Research Center, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT.
Address correspondence and reprint requests to Silvio E. Inzucchi, MD, Section of Endocrinology, Yale University School of
Medicine, 333 Cedar St., TMP 534, P.O. Box 208020, New Haven, CT 06520-8020. E-mail: silvio.inzucchi{at}yale.edu
Abstract
OBJECTIVE —In a recent randomized controlled trial, lowering blood glucose levels to 80–110 mg/dl improved clinical outcomes in critically
ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable
guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage
the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides
detailed insulin dosing instructions and requires minimal physician input.
RESEARCH DESIGN AND METHODS —We collected data from 52 medical intensive care unit (MICU) patients who were placed on the IIP. Blood glucose levels were
the primary outcome measurement. Relevant clinical variables and insulin requirements were also recorded. MICU nurses were
surveyed regarding their experience with the IIP.
RESULTS —To date, our IIP has been employed 69 times in 52 patients admitted to an MICU. Using the IIP, the median time to reach target
blood glucose levels (100–139 mg/dl) was 9 h. Once blood glucose levels fell below 140 mg/dl, 52% of 5,808 subsequent hourly
blood glucose values fell within our narrow target range; 66% within a “clinically desirable” range of 80–139 mg/dl; and 93%
within a “clinically acceptable” range of 80–199 mg/dl. Only 20 (0.3%) blood glucose values were <60 mg/dl, none of which
resulted in clinically significant adverse events. In general, the IIP was readily accepted by our MICU nursing staff, most
of whom rated the protocol as both clinically effective and easy to use.
CONCLUSIONS —Our nurse-implemented IIP is safe and effective in improving glycemic control in critically ill patients.
APACHE II, Acute Physiology And Chronic Health Evaluation II
ICU, intensive care unit
IIP, insulin infusion protocol
MICU, medical ICU
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted October 21, 2003.
Received August 4, 2003.
DIABETES CARE |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0149-5992 1935-5548 |
| DOI: | 10.2337/diacare.27.2.461 |