Introduction and evaluation of a computerised insulin protocol.
OBJECTIVE
To lower glucose levels in all patients in the intensive care unit (ICU) to the target range of 4.5-7.5 mmol/l using a nurse-driven computerised insulin protocol in combination with bedside glucose measurement.


METHODS
Cohort study.


METHODS
Mixed adult ICU.


METHODS
All 182 patients admitted to the ICU during a 3-month period were studied, except for 3 patients admitted for diabetic keto-acidosis.


METHODS
Five steps were taken to improve glucose regulation: (1) Nurses were authorised to adjust insulin dosage using a protocol. (2) Glucose was measured more often. (3) Glucose was measured at the bedside. (4) Consecutive protocols aimed for successively lower glucose levels; the final protocol had a target range of 4.5-7.5 mmol/l. (5) The protocol was computerised. MEASUREMENTS AND RESULT: Mean glucose decreased from 9.23 mmol/l without protocol to 7.68 mmol/l with the final protocol. This final protocol with the target of 4.5-7.5 mmol/l was evaluated more extensively. Glucose levels were measured a total of 1854 times in 179 ICU admissions during 552 ICU treatment days. The median glucose level was 7.0 mmol/l, and 53.1% of glucose measurements were within the target range of 4.5-7.5 mmol/l. One episode of hypoglycaemia (glucose </= 2.2 mmol/l) occurred, representing 0.5% of patients or 0.05% of glucose measurements.


CONCLUSIONS
The combined strategy of successively more ambitious nurse-driven (computerised) insulin protocols and bedside glucose measurement resulted in acceptably low glucose levels with very few episodes of hypoglycaemia.
Meynaar
Iwan A
IA
Intensive Care Unit, Reinier de Graaf Hospital, PO Box 5011, 2600 GA, Delft, Netherlands. meynaar@rdgg.nl
Dawson
Lilian
L
Tangkau
Peter L
PL
Salm
Eduard F
EF
Rijks
Lode
L
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019095:Point-of-Care Systems
D001786:Blood Glucose; D007328:Insulin