Memoirs of a root canal salesman: the successful implementation of a hospital-wide intravenous insulin infusion protocol.
OBJECTIVE
To summarize key metabolic results from use of the Yale Insulin Infusion Protocols (IIPs), as well as the primary barriers to their implementation. To offer practical suggestions for overcoming these barriers, drawing from our experiences "selling root canals" during the successful implementation of our hospital-wide IIPs.


METHODS
Since 2002, Yale IIPs have been employed to achieve strict glycemic control in our ICU patients. Barriers to protocol implementation were noted, and strategies were designed to overcome these barriers.


RESULTS
In 2002, we implemented Version 1 of the Yale IIP, which purposefully targeted conservative blood glucose (BG) levels of 100 to 139 mg/dL. Following extensive hospital-wide experience with Version 1, Version 2 of the IIP (which debuted in 2004) successfully lowered BG targets to 90 to 119 mg/dL, with minimal impact on observed rates of hypoglycemia. These nurse-driven protocols safely and effectively controlled glucose levels in our ICU patients, without the need for ongoing physician supervision.


CONCLUSIONS
This work describes the successful implementation of an evolving hospital-wide IIP. To be successful, an IIP must account for the following essential elements: (1) the current BG level, (2) the velocity of glycemic change, and (3) the current insulin infusion rate. We have reviewed five "points of emphasis" to consider when implementing an IIP.
Goldberg
Philip A
PA
Section of Endocrinology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
D001786:Blood Glucose / Q000032:analysis; D006761:Hospitals; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control; D007262:Infusions, Intravenous; D007332:Insulin Infusion Systems / Q000592:standards*; D007362:Intensive Care Units; D005791:Patient Care / Q000379:methods* / Q000592:standards
D001786:Blood Glucose