Evaluation of nursing adherence to a paper-based graduated continuous intravenous regular human insulin infusion algorithm
| Autor: | Roland N. Dickerson, Gayle Minard, Jessica L. Johnson, George O. Maish, Rex O. Brown |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Blood Glucose Critical Illness Endocrinology Diabetes and Metabolism medicine.medical_treatment Nurses Enteral administration Clinical Protocols Nursing Human insulin Humans Insulin Medicine Medical nutrition therapy Infusions Intravenous Aged Glucose Metabolism Disorders Retrospective Studies Glycemic Nutrition and Dietetics Adult patients business.industry Incidence Paper based Middle Aged Hypoglycemia Intensive Care Units Parenteral nutrition Hyperglycemia Practice Guidelines as Topic Clinical Competence Guideline Adherence Patient Safety business Algorithm Algorithms |
| Zdroj: | Nutrition. 28:1008-1011 |
| ISSN: | 0899-9007 |
| Popis: | The use of continuous intravenous regular human insulin (RHI) infusion is often necessary to achieve glycemic control in critically ill patients. Because insulin is a high-risk medication owing to the potential for severe hypoglycemia, it is imperative that insulin infusion algorithms are designed to be safe, effective, and instructionally clear. The safety and efficacy of our intravenous RHI infusion algorithm protocol has been previously established (Nutrition 2008;24:536-45); however, the protocol violations by nursing personnel were not examined. The objective of this study was to assess nursing adherence to our RHI infusion algorithm.Continuous RHI infusion algorithm violations were retrospectively evaluated in adult patients admitted to a trauma intensive care unit who received concurrent continuous enteral and/or parenteral nutrition therapy and our algorithm for at least 3 d. Blood glucose (BG) monitoring was done every 1 to 2 h with the target BG at 70 to 149 mg/dL (3.9 to 8.3 mmol/L). Nursing adherence to the RHI infusion protocol was evaluated for each patient by comparing the adjustments in insulin infusion rates documented by the nursing personnel with the prescribed adjustments per our graduated continuous intravenous RHI infusion algorithm.A total of 4150 BG measurements necessitating the determination of the appropriate RHI dosage rate by nursing personnel in 40 patients occurred during the observational period. The target BG was achieved for a mean of 20 h/d and none of the patients had an episode of severe hypoglycemia (BG40 mg/dL or 2.2 mmol/L). The overall rate of algorithm violations was 12.1%. The algorithm violations accounted for a single episode of mild to moderate hypoglycemia (BG 40 to 60 mg/dL or 2.2 to 3.3 mmol/L) in 4 patients and 65 total episodes of hyperglycemia (BG ≥150 mg/dL or 8.3 mmol/L) in 18 patients.An adherence rate of nearly 90% is indicative of excellent nursing adherence compared with other published paper-based algorithms that examined protocol adherence. These data, combined with our previously published glycemic control data, indicate that this RHI infusion algorithm is an effective one for hyperglycemic trauma patients receiving continuous enteral and/or parenteral nutritional therapy. |
| Databáze: | OpenAIRE |
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