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Nurse-Directed Blood Glucose Management in a Medical Intensive Care Unit
Friederike Compton1,2,3, Robert Ahlborn4,5,6, Torsten Weidehoff4,5,6
1Friederike Compton is an internist, nephrologist, and intensive care specialist and is the director of the medical intensive care unit of the Department of Nephrology, Charité Campus Benjamin Franklin, Berlin, Germany. friederike.compton@charite.de.
Background:
Insulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy.
Objectives:
To evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload.
Methods:
A nurse-directed protocol for blood glucose management was developed by an interprofessional team, and the protocol's performance was investigated in 175 patients compared with 384 historical controls.
Results:
With the nurse-directed protocol, hypoglycemia incidents declined significantly (31% vs 12%, P < .001), and minimum blood glucose levels increased significantly (80 mg/dL vs 93 mg/dL, P < .001). Mean and maximum blood glucose levels, the proportion of glucose readings within the target range (31% vs 26%, P = .06), and the number of blood glucose checks (59 vs 58, P = .85) remained unchanged with use of the protocol.
Conclusion:
Implementation of the nurse-directed protocol for blood glucose management did not increase nursing workload but reduced hypoglycemia incidents significantly while maintaining adequate glycemic control.
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