Computer-based insulin infusion protocol improves glycemia control over manual protocol.
OBJECTIVE
Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an intravenous insulin protocol integrated into a care provider order entry (CPOE) system.


METHODS
Retrospective before-after study of consecutive adult patients admitted to a SICU during pre (manual protocol, 32 days) and post (computer-based protocol, 49 days) periods.


METHODS
Percentage of glucose readings in ideal range of 70-109 mg/dl, and minutes spent in ideal range of control during the first 5 days of SICU stay.


RESULTS
The computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on IV insulin for > or =24 hours. Hypoglycemia (<40 mg/dl) was rare in both groups.


CONCLUSIONS
The CPOE-based intravenous insulin protocol improved glycemia control in SICU patients compared to a previous manual protocol, and reduced time to insulin therapy initiation. Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in SICU patients.
Boord
Jeffrey B
JB
Vanderbilt University, Division of Cardiovascular Medicine, Nashville, TN 37232-8802, USA. jeffrey.boord@vanderbilt.edu
Sharifi
Mona
M
Greevy
Robert A
RA
Griffin
Marie R
MR
Lee
Vivian K
VK
Webb
Ty A
TA
May
Michael E
ME
Waitman
Lemuel R
LR
May
Addison K
AK
Miller
Randolph A
RA
D001786:Blood Glucose / Q000378:metabolism; D016638:Critical Illness / Q000628:therapy; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D050316:Medical Order Entry Systems; D008875:Middle Aged; D012189:Retrospective Studies; D018511:Systems Integration; D014584:User-Computer Interface
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin