Effects of blood glucose transcription mismatches on a computer-based intensive insulin therapy protocol

• Published in: Intensive care medicine 2010-09, Vol.36 (9), p.1566-1570
• Main Authors: Campion, Thomas R., May, Addison K., Waitman, Lemuel R., Ozdas, Asli, Gadd, Cynthia S.
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Attitude of Health Personnel; Biological and medical sciences; Blood sugar; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Care and treatment; Clinical decision making; Comparative analysis; Critical care; Critical Care Medicine; Critical Illness - therapy; Decision Making, Organizational; Decision support systems; Decision Support Systems, Clinical - organization & administration; Decision Support Systems, Clinical - statistics & numerical data; Diabetes therapy; Drug dosages; Drug Therapy, Computer-Assisted; Emergency Medicine; Genetic transcription; Glucose; Humans; Hyperglycemia; Hyperglycemia - drug therapy; Hypoglycemia; Hypoglycemic Agents - therapeutic use; Informatics; Insulin; Insulin - therapeutic use; Insulin resistance; Intensive; Intensive care; Intensive care medicine; Intensive Care Units - organization & administration; Internet resources; Libraries; Medical colleges; Medical Errors - prevention & control; Medical Errors - statistics & numerical data; Medical Order Entry Systems - organization & administration; Medical Order Entry Systems - statistics & numerical data; Medical sciences; Medicine; Medicine & Public Health; Original; Pain Medicine; Patients; Pediatrics; Pneumology/Respiratory System; Retrospective Studies; Safety Management - organization & administration; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; United States
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-1868-7

Purpose Computerized clinical decision support systems (CDSS) for intensive insulin therapy (IIT) generate recommendations using blood glucose (BG) values manually transcribed from testing devices to computers, a potential source of error. We quantified the frequency and effect of blood glucose transcription mismatches on IIT protocol performance. Methods We examined 38 months of retrospective data for patients treated with CDSS IIT in two intensive care units at one teaching hospital. A manually transcribed BG value not equal to a corresponding device value was deemed mismatched. For mismatches we recalculated CDSS recommendations using device BG values. We compared matched and mismatched data in terms of CDSS alerts, blood glucose variability, and dosing. Results Of 189,499 CDSS IIT instances, 5.3% contained mismatched BG values. Mismatched data triggered 93 false alerts and failed to issue 170 alerts for nurses to notify physicians. Four of six BG variability measures differed between matched and mismatched data. Overall insulin dose was greater for matched than mismatched [matched 3.8 (1.6–6.0), median (interquartile range, IQR), versus 3.6 (1.6–5.7); p