title: Effect of a computerized insulin dose calculator on the process of glycemic control.
abstract: BACKGROUND
  Glycemic control is important to patients' outcomes. However, the process of maintaining glycemic control is risk laden and labor intensive for nurses.
  
  
  OBJECTIVE
  To examine the effects of using a computerized insulin dose calculator to facilitate management of glycemic control for critically ill cardiac patients.
  
  
  METHODS
  A prospective randomized controlled trial was conducted with a sample of 300 intensive care patients, 141 randomized to the calculator group and 159 in the control (paper protocol) group. A convenience sample of 44 intensive care nurses responded to a nurse satisfaction survey.
  
  
  RESULTS
  A significantly higher percentage of glucose measurements were in the target range in the calculator group than in the control group (70.4% [SD, 15.2%] vs 61.6% [SD, 17.9%], Z = -4.423, P < .001), and glucose variance was significantly less in the calculator group (35.5 [SD, 18.3] mg/dL vs 42.3 [SD, 21.2] mg/dL, Z = -3.845, P < .001). Fewer hypoglycemic events occurred in the calculator group (7 vs 18), although this difference was not statistically significant. Nurse satisfaction was higher for the calculator group than for the control group (8.4 [SD, 1.4] vs 4.8 [SD, 2.4], Z = -5.055, P < .001). Nurses' deviation from the protocol was also less in the calculator group than in the control group.
  
  
  CONCLUSIONS
  Management of glycemic control and nurse satisfaction were improved with use of the dose calculator. Improving nurses' processes of care may improve nurses' use of time and patient care overall. Studies with larger sample sizes over time are needed to determine these relationships.
authors.affiliation: Winchester Medical Center in Winchester, Virginia, USA. cdumont@valleyhealthlink.com
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dumont
authors.forename: Cheryl
authors.initials: C
authors.lastname: Bourguignon
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D016638:Critical Illness / Q000451:nursing*; D004360:Drug Therapy, Computer-Assisted; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000517:prevention & control; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012984:Software; D013903:Thoracic Surgery
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin