Computerized Insulin Calculator and Glycemic Control
Computerized Insulin Calculator and Glycemic Control
Background Glycemic control is important to patients' outcomes. However, the process of maintaining glycemic control is risk laden and labor intensive for nurses.
Objectives To examine the effects of using a computerized insulin dose calculator to facilitate management of glycemic control for critically ill cardiac patients.
Methods A prospective randomized controlled trial was conducted with a sample of 300 intensive care patients, 141 randomized to the calculator group and 159 in the control (paper protocol) group. A convenience sample of 44 intensive care nurses responded to a nurse satisfaction survey.
Results A significantly higher percentage of glucose measurements were in the target range in the calculator group than in the control group (70.4% [SD, 15.2%] vs 61.6% [SD, 17.9%], Z = −4.423, P < .001), and glucose variance was significantly less in the calculator group (35.5 [SD, 18.3] mg/dL vs 42.3 [SD, 21.2] mg/dL, Z = −3.845, P < .001). Fewer hypoglycemic events occurred in the calculator group (7 vs 18), although this difference was not statistically significant. Nurse satisfaction was higher for the calculator group than for the control group (8.4 [SD, 1.4] vs 4.8 [SD, 2.4], Z = −5.055, P < .001). Nurses' deviation from the protocol was also less in the calculator group than in the control group.
Conclusions Management of glycemic control and nurse satisfaction were improved with use of the dose calculator. Improving nurses' processes of care may improve nurses' use of time and patient care overall. Studies with larger sample sizes over time are needed to determine these relationships.
While medical researchers seek to determine the ideal targets for glucose concentration, nurses struggle to achieve those targets safely. In the past decade, the recommended glucose concentration target for critically ill patients has increased from 80 to 110 mg/dL (to convert to millimoles per liter, multiply by 0.0555) to the currently recommended target of 140 to 180 mg/dL. Targets less than 110 mg/dL are no longer recommended. Regardless of the target range, controlling the variability of glucose concentrations within that range is difficult, especially in critically ill patients. The most effective way to provide glucose control in critically ill patients is with an intravenous insulin infusion, but the process of glucose control is costly, labor intensive, and risk laden. This study addressed the value of using computer-based technology to assist nurses in the process of glucose control.
Abstract and Introduction
Abstract
Background Glycemic control is important to patients' outcomes. However, the process of maintaining glycemic control is risk laden and labor intensive for nurses.
Objectives To examine the effects of using a computerized insulin dose calculator to facilitate management of glycemic control for critically ill cardiac patients.
Methods A prospective randomized controlled trial was conducted with a sample of 300 intensive care patients, 141 randomized to the calculator group and 159 in the control (paper protocol) group. A convenience sample of 44 intensive care nurses responded to a nurse satisfaction survey.
Results A significantly higher percentage of glucose measurements were in the target range in the calculator group than in the control group (70.4% [SD, 15.2%] vs 61.6% [SD, 17.9%], Z = −4.423, P < .001), and glucose variance was significantly less in the calculator group (35.5 [SD, 18.3] mg/dL vs 42.3 [SD, 21.2] mg/dL, Z = −3.845, P < .001). Fewer hypoglycemic events occurred in the calculator group (7 vs 18), although this difference was not statistically significant. Nurse satisfaction was higher for the calculator group than for the control group (8.4 [SD, 1.4] vs 4.8 [SD, 2.4], Z = −5.055, P < .001). Nurses' deviation from the protocol was also less in the calculator group than in the control group.
Conclusions Management of glycemic control and nurse satisfaction were improved with use of the dose calculator. Improving nurses' processes of care may improve nurses' use of time and patient care overall. Studies with larger sample sizes over time are needed to determine these relationships.
Introduction
While medical researchers seek to determine the ideal targets for glucose concentration, nurses struggle to achieve those targets safely. In the past decade, the recommended glucose concentration target for critically ill patients has increased from 80 to 110 mg/dL (to convert to millimoles per liter, multiply by 0.0555) to the currently recommended target of 140 to 180 mg/dL. Targets less than 110 mg/dL are no longer recommended. Regardless of the target range, controlling the variability of glucose concentrations within that range is difficult, especially in critically ill patients. The most effective way to provide glucose control in critically ill patients is with an intravenous insulin infusion, but the process of glucose control is costly, labor intensive, and risk laden. This study addressed the value of using computer-based technology to assist nurses in the process of glucose control.
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