Introducing intensive insulin therapy: the nursing perspective.

Area of Science:

• Critical Care Medicine
• Endocrinology
• Nursing Practice

Background:

• Intensive insulin therapy (IIT) is proven to reduce mortality and morbidity in critically ill patients with hyperglycemia.
• Limited literature exists on the practical implementation and challenges of IIT protocols in clinical settings.
• Successful IIT requires addressing practical aspects beyond glycemic control itself.

Purpose of the Study:

• To document the development process of an IIT protocol in a district general hospital's critical care unit.
• To identify and analyze the difficulties encountered during the implementation of the nurse-led IIT protocol.
• To provide insights into successful IIT implementation strategies in critical care.

Main Methods:

• Development of a nurse-led intensive insulin therapy protocol.
• Qualitative audit conducted during protocol development and implementation phases.
• Regular feedback sessions with nursing staff to identify and address issues.
• Modification of unit feeding and drug dilution policies based on audit findings.

Main Results:

• Qualitative audit revealed challenges leading to practice changes for individual nurses.
• Key changes included hourly blood glucose monitoring using bedside glucometers.
• Unit feeding and drug dilution policies were modified to prevent glucose instability.
• Other unit protocols impacting glucose control were identified and adjusted.

Conclusions:

• Successful implementation of intensive insulin therapy necessitates adapting working practices and related unit protocols.
• Identifying and modifying factors causing glucose instability is crucial for effective IIT.
• Addressing the increased nursing workload and providing staff support are essential for sustained IIT success.