Evaluation of a Nurse-Managed Insulin Infusion Protocol

Area of Science:

• Clinical Medicine
• Endocrinology
• Metabolic Disorders

Background:

• Insulin infusion protocols are crucial for managing hyperglycemia in hospitalized patients.
• Optimizing blood glucose (BG) control is essential for improving patient outcomes.
• Evaluating protocol performance and adherence is key to refining clinical practice.

Purpose of the Study:

• To assess the efficacy of an insulin infusion protocol targeting a BG of 140-180 mg/dL.
• To characterize adherence to the insulin infusion protocol.
• To identify factors influencing protocol performance and adherence.

Main Methods:

• Retrospective observational cohort study (January 2012 - May 2013).
• Performance metrics analyzed for all patients and those with initial BG ≥200 mg/dL.
• Protocol adherence assessed in a subset of patients, including all with hypoglycemia.

Main Results:

• Mean time to goal BG was 7.1 hours for patients with initial BG ≥200 mg/dL.
• 43.9% of BG values were within the 140-180 mg/dL target; 80.3% were within 80-199 mg/dL.
• Hypoglycemia rate was 0.14 per 100 hours; protocol violations were higher in hypoglycemic and cardiac surgery patients.

Conclusions:

• The protocol achieves adequate BG control (80-199 mg/dL) but not the narrower 140-180 mg/dL target.
• A low incidence of hypoglycemia was observed.
• Further research is needed to address hypoglycemia risk factors and adherence barriers in cardiac surgery patients.