Evaluation of the Effectiveness of a Revised Critical Care Continuous Insulin Infusion Protocol Hallie Dankewich, Megan Freeman, Sarah Murphy Northside Hospital - Atlanta, GA
Background/Purpose: Currently, Northside Hospital utilizes a protocol with a tighter blood glucose (BG) goal in the ICU (120-150 mg/dL) and a standard control protocol for DKA and non-ICU units (150-180 mg/dL). Historically, it was recommended that critically ill patients achieve tighter glucose control. However, American Diabetes Association (ADA) guidelines now recommend a target BG of 140-180 mg/dL in most critically and non-critically ill patients. The purpose of this study is to evaluate an updated insulin infusion protocol with a common goal blood glucose.
Methodology: Retrospective review was conducted analyzing median blood glucose before insulin infusion, time within glycemic targets, and rates of hypoglycemia prior to implementation of the updated protocol. In the next study phase, similar outcomes will be analyzed post-implementation of an updated insulin infusion protocol.
Results: 100 patients were included in the retrospective review. Median pre-infusion BG for the tight control group was 303 mg/dL and was 438 mg/dL for the standard control group. While receiving the insulin infusion, the median BG for the tight control group was 158 mg/dL and median BG for the standard control group was 183 mg/dL. Hypoglycemia occurred in 7 patients (14%) in the tight control group and 4 patients (8%) in the standard group. Additionally, 46% of the drips were in compliance with the protocol used.
Conclusions: Preliminary data demonstrates a median BG above the goal range for both the tight control and standard control groups. Hypoglycemia was more common in the tight control group. There is opportunity for improvement in protocol compliance which will be evaluated following the next study phase.
Presentation Objective: Explain how implementation of a new insulin infusion protocol effects compliance, efficacy, and hypoglycemia.
Self-Assessment: Does implementing a revised insulin infusion protocol to target a blood glucose of 140-180 mg/dL improve protocol compliance and reduce hypoglycemia?
