title: Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit.
abstract: BACKGROUND
  Recent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units.
  
  
  OBJECTIVE
  To evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit.
  
  
  METHODS
  A nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion.
  
  
  RESULTS
  Ninety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P<.001) were within the target glucose range (110-149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose <70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P<.001).
  
  
  CONCLUSIONS
  Implementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia.
authors.affiliation: Medical ICU, Hadassah–Hebrew University Medical Center, P. O. Box 91120, Jerusalem, Israel. rabeik@hotmail.com
authors.forename: Rabia
authors.initials: R
authors.lastname: Khalaila
authors.forename: Eugene
authors.initials: E
authors.lastname: Libersky
authors.forename: Dina
authors.initials: D
authors.lastname: Catz
authors.forename: Elina
authors.initials: E
authors.lastname: Pomerantsev
authors.forename: Abed
authors.initials: A
authors.lastname: Bayya
authors.forename: David M
authors.initials: DM
authors.lastname: Linton
authors.forename: Sigal
authors.initials: S
authors.lastname: Sviri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000451:nursing; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D057184:Practice Patterns, Nurses'; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin