Introduction and evaluation of a computerised insulin protocol

Area of Science:

• Critical Care Medicine
• Endocrinology
• Nursing Practice

Background:

• Hyperglycemia is common in intensive care unit (ICU) patients.
• Poor glycemic control is associated with adverse outcomes in critically ill patients.
• Existing protocols for glycemic management in the ICU require optimization.

Purpose of the Study:

• To implement and evaluate a nurse-driven, computerized insulin protocol to achieve target glucose levels (4.5-7.5 mmol/l) in ICU patients.
• To assess the safety and efficacy of this protocol in reducing hyperglycemia and hypoglycemia.

Main Methods:

• A cohort study was conducted in a mixed adult ICU.
• A nurse-driven, computerized insulin protocol was implemented in five steps, including nurse authorization for insulin adjustments, increased glucose monitoring frequency, bedside measurements, and progressively lower glucose targets.
• Data from 179 ICU admissions were analyzed.

Main Results:

• The mean glucose level decreased from 9.23 mmol/l to 7.68 mmol/l with the final protocol.
• In the final protocol phase, the median glucose level was 7.0 mmol/l, with 53.1% of measurements within the target range of 4.5-7.5 mmol/l.
• Only one episode of hypoglycemia (glucose ≤ 2.2 mmol/l) was recorded, representing 0.05% of glucose measurements.

Conclusions:

• A combined strategy of nurse-driven, computerized insulin protocols and bedside glucose monitoring effectively achieved target glucose levels in ICU patients.
• This approach resulted in acceptably low glucose levels with a very low incidence of hypoglycemia.
• The study demonstrates the feasibility and safety of empowering nurses with a computerized protocol for glycemic control in the ICU.