title: Computerisation of a paper-based intravenous insulin protocol reduces errors in a prospective crossover simulated tight glycaemic control study.
abstract: BACKGROUND
  Paper-based continuous intravenous insulin protocols for tight glycaemic control (TGC) are typically complex, error-prone, time-consuming and burdensome. Little is known about the errors that occur as a result of misinterpretation and whether computerised protocols reduce errors.
  
  
  OBJECTIVE
  To compare the errors resulting from protocol misinterpretation, time required to manage insulin infusions and nursing satisfaction between a computerised insulin protocol and a paper-based protocol.
  
  
  METHODS
  In a crossover study, 62 ICU nurses completed 10 TGC simulated scenarios for the computerised and paper protocols. Scenarios evaluated three phases of insulin management: initiation, titration and transition. Scenarios response errors, time to completion and user satisfaction were examined.
  
  
  RESULTS
  A total of 620 responses were recorded using both protocols. The computerised protocols were associated with higher user satisfaction, as well as: fewer errors in the titration (13 vs. 113 errors, p=.0001) and transition phases (9 vs. 23 errors, p=.001), fewer dosing errors, although not statistically significant (p=.096), in the initiation phase, and less time to complete in the titration phase (6 vs. 9.5 min, p=.0001).
  
  
  CONCLUSIONS
  In a simulated environment, a computerised protocol for TGC resulted in significant insulin dosing error reduction, saved time and improved nurse satisfaction.
authors.affiliation: Children's National Medical Center, Washington, DC, United States. Anthony.Lee@nationwidechildrens.org
authors.forename: Anthony
authors.initials: A
authors.lastname: Lee
authors.forename: Badia
authors.initials: B
authors.lastname: Faddoul
authors.forename: Azizeh
authors.initials: A
authors.lastname: Sowan
authors.forename: Karen L
authors.initials: KL
authors.lastname: Johnson
authors.forename: Kristi D
authors.initials: KD
authors.lastname: Silver
authors.forename: Vinay
authors.initials: V
authors.lastname: Vaidya
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D002985:Clinical Protocols; D003201:Computers; D003422:Critical Care / Q000458:organization & administration; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D020407:Internet; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin