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Updated: May 14, 2026

Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Nursing protocol violations: detect, correct and communicate.

Harma Te Beest¹, Cynthia van der Starre, Dick Tibboel

¹Intensive Care Unit, Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.

Nursing in Critical Care

|February 20, 2013

Summary

The Critical Nursing Situation Index (CNSI) effectively identifies nursing protocol violations. This tool aids in timely correction, reducing potential adverse events and highlighting justifiable deviations when documented.

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Last Updated: May 14, 2026

Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Area of Science:

Nursing Quality Improvement
Patient Safety
Healthcare Auditing

Background:

Nursing protocol violations can impact patient safety.
Monitoring and correcting these violations are crucial for quality care.
The Critical Nursing Situation Index (CNSI) was developed to detect such violations.

Purpose of the Study:

To assess the incidence and severity of nursing protocol violations using the CNSI.
To evaluate the implementation of corrective actions for identified violations.
To determine the reliability of nurses' severity classifications for protocol violations.

Main Methods:

A prospective observational audit was conducted in a pediatric Intensive Care Unit.
14 trained nurses utilized the CNSI checklist across nine nursing care domains.
Data collected included violation occurrence, correction status, justifiability, and documentation.

Main Results:

12.2% of checked items (987/8107) showed protocol violations.
Violation rates varied by domain, from 5% (Medication) to 26% (Digestive tract).
Over 50% of violations were corrected, 22.3% were justifiable but poorly documented; severity classification lacked reliability.

Conclusions:

The CNSI is a valuable tool for monitoring and rectifying nursing protocol deviations.
Prompt identification and correction of violations can mitigate adverse events.
Justifiable protocol violations require thorough documentation in clinical practice.