A retrospective cohort study of a nurse-driven computerized insulin infusion program versus a paper-based protocol in critically ill patients.
BACKGROUND
There is variability in the extent of outcome achievement between computerized insulin infusion programs (CIIPs) and paper-based protocols (PBPs). This reported variability may be improved by intensive CIIP training prior to implementation. The objective was to evaluate the impact of a CIIP following intensive nurse training versus a PBP in a critical care setting.


METHODS
A retrospective cohort study was performed on patients admitted to a mixed intensive care unit comparing glucose control between the CIIP following intensive training and a PBP. Consecutive patients on each protocol were assessed to obtain glucose concentrations and outcomes. The primary measure was the percentage of blood glucose values within target range (90-130 mg/dL). Patient glucose values were pooled and assessed using the χ(2) test for independence.


RESULTS
In total, 61 patients with 5,495 glucose tests were included in the PBP group, and 51 patients with 5,645 glucose tests in the CIIP group. A greater percentage of glucose tests was within target range in the CIIP group (68.4% vs. 36.5%, P<0.001). In the CIIP group, time-to-target (median [interquartile range] 5 [3-8] h vs. 7 [4-20] h, P=0.02) and severe hypoglycemic events were reduced (26 vs. 6, P<0.0001).


CONCLUSIONS
The nurse-driven CIIP led to a higher percentage of glucose values within target range, faster achievement of target glucose values, and a reduction in the number of severe hypoglycemic events. This improved outcome achievement compared with previous reports may be associated with intensive user training.
Department of Pharmacy, Roudebush VA Medical Center, Indianapolis, Indiana, USA.
Justin W
JW
Bouw
Noll
N
Campbell
Margie A
MA
Hull
Rattan
R
Juneja
Oscar
O
Guzman
Brian R
BR
Overholser
D000328:Adult; D001786:Blood Glucose / Q000187:drug effects*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000451:nursing; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009726:Nurses; D012189:Retrospective Studies; D013813:Therapy, Computer-Assisted
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin