Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit

• Published in: Critical care nurse 2011-12, Vol.31 (6), p.27-35
• Main Authors: Khalaila, Rabia, Libersky, Eugene, Catz, Dina, Pomerantsev, Elina, Bayya, Abed, Linton, David M, Sviri, Sigal
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Blood Glucose - analysis; Case-Control Studies; Clinical Protocols; Critical Care - methods; Female; Follow-Up Studies; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Infusions, Intravenous - adverse effects; Infusions, Intravenous - nursing; Insulin - administration & dosage; Insulin - adverse effects; Intensive Care Units - organization & administration; Male; Middle Aged; Nursing; Nursing Evaluation Research; Nursing Methodology Research; Practice Patterns, Nurses; Prospective Studies; Retrospective Studies; Treatment Outcome
• ISSN: 0279-5442; 1940-8250
• DOI: 10.4037/ccn2011934

Recent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units. 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. 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. 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