Outcomes of clinical nurse specialist-initiated system-level standardized glucose management

The purpose of this quality improvement project was to determine if the use of standardized insulin orders versus the use of nonstandardized insulin orders improved glucose results in a hospital's critical care unit. A clinical nurse specialist-led interdisciplinary team developed standardized insulin orders with the goal of improving glucose control. Of the 570 patients admitted from July to September 2006, 124 met glucose criteria to use standardized insulin orders. A total of 331 individual glucose results from 16 patients reviewed demonstrated a difference in mean and median when standardized orders were used versus when they were not used to control glucose. A mean glucose of 175 mg/dL and median glucose of 149 mg/dL were the outcomes when standardized insulin orders were used versus a mean glucose of 206 mg/dL and median glucose of 190 mg/dL when standardized orders were not used. System change efforts to improve glucose control resulted in improved staff nurse empowerment, improved provider knowledge of glucose control methods, and improved patient glucose control in this Midwestern hospital.