Nursing involvement improves compliance with tight blood glucose control in the trauma ICU: a prospective observational study.
BACKGROUND
The importance of tight glycaemic control has gained acceptance over the last 5 years as a critical component of routine intensive care unit (ICU) measures. In an environment already strained for resources and staffing, however, effective strategies providing for increased input and responsibility of bedside nursing personnel are paramount to successful implementation.


OBJECTIVE
Increasing input and responsibilities of ICU nursing staff in tight glycaemic control policies improves glucose control in the trauma ICU.


METHODS
After Institutional Review Board approval, we conducted a prospective "before-after" trial examining the effect of nursing education and input on outcome of a tight (goal 80-120 mg/dL) glycaemic control protocol. After a three month assessment of compliance with a previously physician-developed protocol, an educational in-service was conducted for all trauma ICU nursing staff. Nursing staff were then asked to provide input on the development of a new protocol using multiple-choice ballots to define 7 components of protocol criteria. Using nursing input, we developed and implemented a new glycaemic protocol that shifted much of the responsibility for initiation and subsequent adjustment of insulin infusion to the bedside nurse, allowing them to more liberally utilise their bedside clinical judgment and knowledge of the specific patient.


RESULTS
Nursing input on seven factors of protocol criteria did not differ significantly from the previously existing protocol, except with reference to nursing desire for increased responsibility in the implementation and maintenance of tight glycaemic control. After three months implementation of a new protocol developed utilising nursing input, both mean blood glucose levels achieved (137.8 mg/dL vs. 128.2mg/dL, p=0.028) and time to first hourly blood glucose within goal range (<120 mg/dL) was improved (36 h vs. 9h). The number of hypoglycaemic (BS <60) episodes increased slightly after revision (1 event vs. 5 event), with no hypoglycaemic seizures or coma occurring during either period.


CONCLUSIONS
Nursing input and increased responsibility improved the results of a tight glycaemic control in our trauma ICU. Increasing nursing input in the development and implementation of a tight glycaemic policies can result in safe and effective improved glucose control in the trauma ICU.
DuBose
Joseph J
JJ
Los Angeles County Hospital, University of Southern California School of Medicine, Los Angeles, CA, USA. jdubose@surgery.usc.edu
Nomoto
Shirley
S
Higa
Liliana
L
Paolim
Ramona
R
Teixeira
Pedro G R
PG
Inaba
Kenji
K
Demetriades
Demetrios
D
Belzberg
Howard
H
D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D003422:Critical Care / Q000458:organization & administration* / Q000523:psychology; D003659:Decision Making, Organizational; D004509:Education, Nursing, Continuing / Q000458:organization & administration; D019983:Guideline Adherence / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D024802:Nurse's Role / Q000523:psychology; D009731:Nursing Audit; D015402:Nursing Education Research; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D011446:Prospective Studies; D016037:Single-Blind Method
D007004:Hypoglycemic Agents; D007328:Insulin