Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit.
BACKGROUND
Tight glucose control by intensive insulin therapy has become a key part of critical care and is an important field of study in acute coronary care. A balance has to be found between frequency of measurements and the risk of hypoglycemia. Current nurse-driven protocols are paper-based and, therefore, rely on simple rules. For safety and efficiency a computer decision support system that employs complex logic may be superior to paper protocols.


METHODS
We designed and implemented GRIP, a stand-alone Java computer program. Our implementation of GRIP will be released as free software. Blood glucose values measured by a point-of-care analyzer were automatically retrieved from the central laboratory database. Additional clinical information was asked from the nurse and the program subsequently advised a new insulin pump rate and glucose sampling interval.


RESULTS
Implementation of the computer program was uneventful and successful. GRIP treated 179 patients for a total of 957 patient-days. Severe hypoglycemia (< 2.2 mmol/L) only occurred once due to human error. With a median (IQR) of 4.9 (4.2-6.2) glucose measurements per day the median percentage of time in which glucose fell in the target range was 78%. Nurses rated the program as easy to work with and as an improvement over the preceding paper protocol. They reported no increase in time spent on glucose control.


CONCLUSIONS
A computer driven protocol is a safe and effective means of glucose control at a surgical ICU. Future improvements in the recommendation algorithm may further improve safety and efficiency.
Vogelzang
Mathijs
M
Department of Surgery, Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.vogelzang@thorax.umcg.nl
Zijlstra
Felix
F
Nijsten
Maarten W N
MW
D000368:Aged; D000465:Algorithms; D001291:Attitude of Health Personnel; D001322:Autoanalysis; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D020000:Decision Support Systems, Clinical; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000451:nursing / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009741:Nursing Staff, Hospital / Q000523:psychology; D019095:Point-of-Care Systems; D011182:Postoperative Care / Q000451:nursing* / Q000592:standards; D011381:Programming Languages
D001786:Blood Glucose; D007328:Insulin