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Updated: Mar 7, 2026
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
A Pediatric Intensive Care Unit Bedside Computer Clinical Decision Support Protocol for Hyperglycemia Is Feasible,
Eliotte L Hirshberg1,2,3,4, Michael J Lanspa1,3, Emily L Wilson1,2
11 Pulmonary and Critical Care Division, Intermountain Medical Center , Murray, Utah.
Insights
A new computer clinical decision support (CDS) system, eProtocol-insulin, safely managed blood glucose in critically ill children. This system improved glucose control compared to traditional methods, demonstrating its value in pediatric intensive care units (PICUs).
Area of Science:
- Pediatric Intensive Care
- Clinical Decision Support Systems
- Glycemic Control
Background:
- Clinical decision support (CDS) systems are underutilized in pediatric intensive care units (PICUs), despite proven benefits in adult ICUs.
- A bedside CDS protocol for intravenous insulin titration, eProtocol-insulin, was developed to assess feasibility and safety in critically ill children.
Purpose of the Study:
- To evaluate the safety and efficacy of eProtocol-insulin compared to unaided clinician titration for intravenous insulin management in non-diabetic critically ill children with elevated blood glucose.
- To assess nurse satisfaction and clinician compliance with the eProtocol-insulin system.
Main Methods:
- Retrospective review of data from non-diabetic children in the PICU with blood glucose (BG) ≥140 mg/dL, managed with either eProtocol-insulin or unaided clinician titration.
- Primary outcomes included BG measurements in the target range (80-110 mg/dL) and severe hypoglycemia (BG ≤40 mg/dL).
- Secondary outcomes included 60-day mortality, PICU length of stay, nurse satisfaction, and clinician compliance.
Main Results:
- eProtocol-insulin achieved target BG range more frequently (41% vs. 32%, P<0.001) than clinician titration.
- Severe hypoglycemia was rare and not significantly different between groups (4.3% vs. 8.7%, P=0.37).
- Clinician compliance with eProtocol-insulin was high (89%), and nurses found it easy to understand and safer than unaided titration.
Conclusions:
- The eProtocol-insulin system is safe and effective for intravenous insulin titration in critically ill children.
- Computerized protocols are recommended for optimizing blood glucose control and ensuring replicable clinical decisions in pediatric critical care.
Background:
Computer clinical decision support (CDS) systems are uncommon in the pediatric intensive care unit (PICU), despite evidence suggesting they improve outcomes in adult ICUs. We reasoned that a bedside CDS protocol for intravenous insulin titration, eProtocol-insulin, would be feasible and safe in critically ill children.
Methods:
We retrospectively reviewed data from non-diabetic children admitted to the PICU with blood glucose (BG) ≥140 mg/dL who were managed with intravenous insulin by either unaided clinician titration or eProtocol-insulin. Primary outcomes were BG measurements in target range (80-110 mg/dL) and severe hypoglycemia (BG ≤40 mg/dL); secondary outcomes were 60-day mortality and PICU length of stay. We assessed bedside nurse satisfaction with the eProtocol-insulin protocol by using a 5-point Likert scale and measured clinician compliance with eProtocol-insulin recommendations.
Results:
Over 5 years, 69 children were titrated with eProtocol-insulin versus 104 by unaided clinicians. eProtocol-insulin achieved target range more frequently than clinician titration (41% vs. 32%, P < 0.001). Severe hypoglycemia was uncommon in both groups (4.3% of patients in eProtocol-insulin, 8.7% in clinician titration, P = 0.37). There were no differences in mean time to BG target or median BG between the groups. Mortality was 23% in both groups. Clinician compliance with eProtocol-insulin recommendations was 89%. Nurses believed that eProtocol-insulin was easy to understand and safer than clinician titration.
Conclusions:
eProtocol-insulin is safe for titration of intravenous insulin in critically ill children. Clinical research protocols and quality improvement initiatives aimed at optimizing BG control should utilize detailed computer protocols that enable replicable clinician decisions.
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