An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units

Mark A. Malesker, Pamela A. Foral, Keith J. Christensen, Daniel E. Hilleman, Julie A. Chang, Ann C. McPhillips

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)589-598
Number of pages10
JournalAmerican Journal of Critical Care
Volume16
Issue number6
StatePublished - Nov 2007
Externally publishedYes

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Intensive Care Units
Blood Glucose
Nurses
Workload
Hypoglycemia
Hyperglycemia
Insulin

All Science Journal Classification (ASJC) codes

  • Critical Care
  • Medicine(all)
  • Nursing(all)

Cite this

An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units. / Malesker, Mark A.; Foral, Pamela A.; Christensen, Keith J.; Hilleman, Daniel E.; Chang, Julie A.; McPhillips, Ann C.

In: American Journal of Critical Care, Vol. 16, No. 6, 11.2007, p. 589-598.

Research output: Contribution to journalArticle

Malesker, Mark A. ; Foral, Pamela A. ; Christensen, Keith J. ; Hilleman, Daniel E. ; Chang, Julie A. ; McPhillips, Ann C. / An Efficiency Evaluation of Protocols for Tight Glycemic Control in Intensive Care Units. In: American Journal of Critical Care. 2007 ; Vol. 16, No. 6. pp. 589-598.
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