title: An efficiency evaluation of protocols for tight glycemic control in intensive care units.
abstract: BACKGROUND
  The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals.
  
  
  OBJECTIVE
  To evaluate the efficiency of protocols for tight glycemic control used in intensive care units.
  
  
  METHODS
  Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses.
  
  
  RESULTS
  Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason.
  
  
  CONCLUSIONS
  Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.
authors.affiliation: Department of Pharmacy Practice, Creighton University Medical Center, Omaha, Nebraska 68178, USA. malesker@creighton.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Malesker
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Foral
authors.forename: Ann C
authors.initials: AC
authors.lastname: McPhillips
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Christensen
authors.forename: Julie A
authors.initials: JA
authors.lastname: Chang
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Hilleman
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D002985:Clinical Protocols; D017598:Efficiency, Organizational; D019538:Health Care Surveys; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000451:nursing / Q000517:prevention & control*; D007003:Hypoglycemia / Q000175:diagnosis / Q000451:nursing / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units / Q000458:organization & administration*; D009329:Nebraska; D009731:Nursing Audit; D012307:Risk Factors; D012720:Severity of Illness Index; D013996:Time and Motion Studies; D016526:Workload
chemical_list: D001786:Blood Glucose; D007328:Insulin