Tiered protocol implementation improves treatment of hypoglycaemia in a neurosciences critical care and surgical intensive care unit

Although studies demonstrate techniques to limit hypoglycaemia in critically ill patients, there are limited data supporting methods to improve management of existing hypoglycaemia. Assess the impact and sustainability of a computerised, three tiered, nurse driven protocol for hypoglycaemia treatmen...

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Bibliographic Details
Published in:Intensive & critical care nursing 2017-12, Vol.43, p.6-11
Main Authors: Van Berkel, Megan A., MacDermott, Jennifer, Dungan, Kathleen M., Cook, Charles H., Murphy, Claire V.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Blood
Blood Glucose - analysis
Cohort Studies
Computerised physician order entry
Critical care
Critical Care Nursing - methods
Critical Care Nursing - standards
Diabetes
Female
Glucose
Glycaemic variability
Guidelines as Topic - standards
Hospitalization
Humans
Hypoglycaemia
Hypoglycemia
Hypoglycemia - diagnosis
Hypoglycemia - drug therapy
Hypoglycemia - nursing
Insulin
Insulin - therapeutic use
Intensive care
Intensive care unit
Intensive Care Units - organization & administration
Intensive Care Units - standards
Length of Stay - statistics & numerical data
Male
Measurement
Middle Aged
Mortality
Neuroscience Nursing - methods
Neuroscience Nursing - standards
Neurosciences
Nursing
Patient care planning
Patients
Protocol
Retrospective Studies
Sepsis
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Summary:Although studies demonstrate techniques to limit hypoglycaemia in critically ill patients, there are limited data supporting methods to improve management of existing hypoglycaemia. Assess the impact and sustainability of a computerised, three tiered, nurse driven protocol for hypoglycaemia treatment. Retrospective pre and post protocol study. Neurosciences and surgical intensive care units at a tertiary academic medical centre. Patients with a hypoglycaemic episode were included during a pre-protocol or post-protocol implementation period. An additional six-month cohort was evaluated to assess sustainability. Fifty-four patients were included for evaluation (35 pre- and 19 post-protocol); 122 patients were included in the sustainability cohort. Hypoglycaemia treatment significantly improved in the post-protocol cohort (20% vs. 52.6%, p=0.014); with additional improvement to 79.5% in the sustainability cohort. Time to follow-up blood glucose was decreased after treatment from 122 [Q1–Q3: 46–242] minutes pre-protocol to 25 [Q1–Q3: 9–48] minutes post protocol (p
ISSN:0964-3397
1532-4036
DOI:10.1016/j.iccn.2017.06.006