BACKGROUND: The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. OBJECTIVES: To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. METHODS: Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. RESULTS: Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. CONCLUSIONS: Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.
BACKGROUND: The efficiency of protocols for tight glycemic control is uncertain despite their adoption in hospitals. OBJECTIVES: To evaluate the efficiency of protocols for tight glycemic control used in intensive care units. METHODS: Three separate studies were performed: (1) a third-party observer used a stopwatch to do a time-motion analysis of patients being treated with a protocol for tight glycemic control in 3 intensive care units, (2) charts were retrospectively reviewed to determine the frequency of deviations from the protocol, and (3) a survey assessing satisfaction with and knowledge of the protocol was administered to full-time nurses. RESULTS: Time-motion data were collected for 454 blood glucose determinations from 38 patients cared for by 47 nurses. Mean elapsed times from blood glucose result to therapeutic action were 2.24 (SD, 1.67) minutes for hypoglycemia and 10.65 (SD, 3.24) minutes for hyperglycemia. Mean elapsed time to initiate an insulin infusion was 32.56 (SD, 12.83) minutes. Chart review revealed 734 deviations from the protocol in 75 patients; 57% (n = 418) were deviations from scheduled times for blood glucose measurements. The mean number of deviations was approximately 9 per patient. Of 60 nurses who responded to the workload survey, 42 (70%) indicated that the protocol increased their workload; frequency of blood glucose determinations was the most common reason. CONCLUSIONS: Nurses spend substantial time administering protocols for tight glycemic control, and considerable numbers of deviations occur during that process. Further educational efforts and ongoing assessment of the impact of such protocols are needed.
Authors: Thomas R Campion; Lemuel R Waitman; Nancy M Lorenzi; Addison K May; Cynthia S Gadd Journal: Int J Med Inform Date: 2011-10-21 Impact factor: 4.046
Authors: Roman Kulnik; Johannes Plank; Christoph Pachler; Malgorzata E Wilinska; Andrea Groselj-Strele; Doris Röthlein; Matthias Wufka; Norman Kachel; Karl Heinz Smolle; Sabine Perl; Thomas Rudolf Pieber; Roman Hovorka; Martin Ellmerer Journal: J Diabetes Sci Technol Date: 2008-11
Authors: Thomas R Campion; Lemuel R Waitman; Addison K May; Asli Ozdas; Nancy M Lorenzi; Cynthia S Gadd Journal: Int J Med Inform Date: 2009-10-07 Impact factor: 4.046
Authors: Jan Blaha; Petr Kopecky; Michal Matias; Roman Hovorka; Jan Kunstyr; Tomas Kotulak; Michal Lips; David Rubes; Martin Stritesky; Jaroslav Lindner; Michal Semrad; Martin Haluzik Journal: Diabetes Care Date: 2009-02-05 Impact factor: 17.152
Authors: Saeid Eslami; Nicolette F de Keizer; Evert de Jonge; Marcus J Schultz; Ameen Abu-Hanna Journal: Crit Care Date: 2008-11-11 Impact factor: 9.097