Implementation of a glucose management protocol to prevent hypo- and hyperglycaemia in critically ill patients

Background  Many healthcare providers acknowledge the importance of encouraging health professionals to base their practice on current evidence. There is a plethora of evidence supporting tight glucose control in critically ill patients to reduce mortality and morbidity and many studies have shown that hyperglycaemia in critically ill patients has been associated with an increased susceptibility to infection and impaired immune response. Methods  This project aimed to improve current practice in the prevention and management of hypo- and hyperglycaemia in critically ill patients based on the best available evidence. The setting for the project was a large public hospital in Brisbane, Queensland, with an 11 bed tertiary referral intensive care unit (ICU) for critically ill adult patients. A pre-implementation audit using a set of evidence-based criteria from a systematic review on tight glucose control in critically ill patients was undertaken. The Joanna Briggs Institute on-line audit and feedback software, paces (Practical Application of Clinical Evidence System), was used to analyse the data to determine ICU's current compliance with established best practice in glucose management. These initial audit results were used to develop an action plan to improve glucose management practice within the unit. This included the development and implementation of a glucose management protocol, the identification of barriers and facilitators and education of clinical staff. Following the implementation of this protocol a post-implementation audit was conducted using the same criteria as in the initial audit. Results  The post audit findings indicated improvement in most areas of glucose management practice within the ICU. Conclusion  The success of this project is not only evident through improved ICU glucose management practice over 12 weeks, but also through clinicians gaining experience in the process of utilising evidence-based recommendations in all areas of practice.