title: Nurse- vs nomogram-directed glucose control in a cardiovascular intensive care unit.
abstract: BACKGROUND
  Paper-based nomograms are reasonably effective for achieving glycemic control but have low adherence and are less adaptive than nurses' judgment.
  
  
  OBJECTIVE
  To compare efficacy (glucose control) and safety (hypoglycemia) achieved by use of a paper nomogram versus nurses' judgment.
  
  
  METHODS
  Prospective, randomized, open-label, crossover trial in an intensive care unit in postoperative patients with glucose concentrations greater than 8 mmol/L. Consenting nurses with at least 1 year of experience were randomized to use either their judgment or a validated paper-based nomogram for glucose control. After completion of 2 study shifts, the nurses used the alternative method for the next 2 study shifts. Glucose target level and safety and efficacy boundaries were the same for both methods. The primary end point was area under glucose time curve per hour.
  
  
  RESULTS
  Thirty-four nurses contributed 95 shifts of data (44 nomogram-directed, 51 nurse-directed). Adherence to the nomogram was higher in the nomogram group than hypothetical adherence in the nurse-directed group for correct adjustments in insulin infusion (70% vs 37%; P < .001) and glucose checks (58% vs 43%; P = .008). The primary end point did not differ between the 2 groups (mean, 9.0 mmol/L; SD, 3.5 vs mean, 8.3 mmol/L; SD, 2.1; P = .08). Glucose variability, amount of time patients were hypoglycemic or hyperglycemic, and number of glucose checks performed were similar in the 2 groups.
  
  
  CONCLUSIONS
  In an intensive care unit where nurses generally accepted the need for tight glucose control, nurse-directed control was as effective and as safe as nomogram-based control.
authors: Pharmacy Department, Critical Care Department at St Michael's Hospital, Toronto, Canada.
authors: Clarence
authors: C
authors: Chant
authors: Mary
authors: M
authors: Mustard
authors: Kevin E
authors: KE
authors: Thorpe
authors: Jan O
authors: JO
authors: Friedrich
mesh_terms: D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D018592:Cross-Over Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000451:nursing*; D049451:Nomograms; D009730:Nursing Assessment; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000517:prevention & control; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin