Evaluation of a Nurse-Managed Insulin Infusion Protocol

Passarelli, A; Gibbs, Haley G.; Rowden, Annette; Efird, Leigh; Zink, Elizabeth K.; Mathioudakis, Nestoras

doi:10.1089/dia.2015.0046

Cited by 9 publications

(12 citation statements)

References 21 publications

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“…Compton et al (2017) found that a rate of 26.0% in reaching the target level of BG had taken 8 hr to finish. TP in this study was found efficient because it achieved a longer time of maintaining the target level of BG and a shorter time for reaching the target than the non-TP group and previous studies (Compton et al, 2017;Passarelli et al, 2016).…”

Section: Efficiency Of Tpmentioning

confidence: 49%

“…It is necessary to maintain target BG and prevent hypoglycaemia to determine the state of effective BG control in applying a BG control protocol (Khalaila et al., 2011; Krinsley et al., 2011; Passarelli et al., 2016). The TP group was 1.4 times more likely to reach the target level of BG than the non‐TP group.…”

Section: Discussionmentioning

confidence: 99%

“…Consideration was given to the efficiency of the protocol, along with effective BG control for critical care in protocol application (Ngalob et al., 2014; Passarelli et al., 2016). In terms of efficiency in BG control, TP was applied for a shorter period of time.…”

Section: Discussionmentioning

confidence: 99%

“…While applying the BG control protocol, time for maintaining the target level of BG formed 42.5% of the total application time in the non-TP group and 69.3% in the TP group. Passarelli et al (2016) found that the BG control protocol had a rate of 43.9% in reaching the target level of BG, which took 7 hr to accomplish. Compton et al (2017) found that a rate of 26.0% in reaching the target level of BG had taken 8 hr to finish.…”

Section: Efficiency Of Tpmentioning

confidence: 99%

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Effectiveness of blood glucose control protocol for open heart surgery patients

Yoo

Suh

Shim

2020

Journal of Advanced Nursing

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Aims To evaluate the effectiveness of a tailored blood glucose control protocol for postoperative cardiac surgery patients treated in intensive care. Design Retrospective study. Methods Data for the control group (non‐tailored protocol) were collected from medical records at a tertiary hospital in Seoul, Korea between April–July 2015. Data for the experimental group (tailored protocol) were obtained from medical records between April–July 2016. After adjusting the target blood glucose range, eliminating single‐dose insulin administration and extending the blood glucose measurement time interval, data for blood glucose measurements, time for reaching and maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments for the experimental group were collected. Results In the experimental group (where the target blood glucose rate was increased) the hypoglycaemia rate and the variation in blood glucose decreased significantly compared with the control group. In particular, the experimental group maintained relatively stable blood glucose levels by retaining a small variation range in glucose, regardless of the presence of diabetes. Time required for maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments per patient decreased. Conclusion The tailored protocol contributes to the safe and effective control of blood glucose in critical care patients after cardiac surgery and to the efficiency of nurses administering it. Impact This study has two significant impacts. The application of the tailored protocol has a positive impact on patients’ blood glucose management, a critical component of treatment for postoperative cardiac patients in intensive care units. It also has a positive impact on the efficiency of nurses applying it. The results of this study are thus expected to facilitate successful implementation of clinical protocols for critical care after heart surgery.

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Section: Efficiency Of Tpmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Efficiency Of Tpmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of blood glucose control protocol for open heart surgery patients

Yoo

Suh

Shim

2020

Journal of Advanced Nursing

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“…After achieving the target, hyperglycaemia represents about 17.7% of the BG measurements under the dynamic algorithm, in the same proportion as in the study of Passarelli et al [21], while the rates reported in another study ranged from 35% to 48% during the 2 nd and 3 rd days of insulin infusion [20]. Indeed, hyperglycaemia is arbitrary and not following hypoglycaemia, suggesting that sugar substitution was warranted.…”

Section: Discussionmentioning

confidence: 69%

Prospective evaluation of a dynamic insulin infusion algorithm for non critically-ill diabetic patients: A before-after study

et al. 2019

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IntroductionInsulin infusion is recommended during management of diabetic patients in critical care units to rapidly achieve glycaemic stability and reduce the mortality. The application of an easy-to-use standardized protocol, compatible with the workload is preferred. Glycaemic target must quickly be reached, therefore static algorithms should be replaced by dynamic ones. The dynamic algorithm seems closer to the physiological situation and appreciates insulin sensitivity. However, the protocol must meet both safety and efficiency requirements. Indeed, apprehension from hypoglycaemia is the main deadlock with the dynamic algorithms, thus their application remains limited. In contrary to the critical care units, to date, no prospective study evaluated a dynamic algorithm of insulin infusion in non-critically ill patients.AimThis study primarily aimed to evaluate the efficacy of a dynamic algorithm of intravenous insulin therapy in non-critically-ill patients, and addressed its safety and feasibility in different departments of our university hospital.MethodsA "before-after" study was conducted in five hospital departments (endocrinology and four “non-expert” units) comparing a dynamic algorithm (during the "after" period-P2) to the static protocol (the “before” period-P1). Static protocol is based on determining insulin infusion according to an instant blood glycaemia (BG) level at a given time. In the dynamic algorithm, insulin infusion rate is determined according to the rate of change of the BG (the previous and actual BG under a specific insulin infusion rate). Additionally, two distinct glycaemic targets were defined according to the patients’ profile: 100–180 mg/dl (5.5–10 mmol/l) for vigorous patients and 140–220 mg/dl (7.8–12.2 mmol/l) for frail ones. Different BG measurements for each patient were collected and recorded in a specific database (e-CRF) in order to analyse the rates of hypo- and hyperglycaemia. A satisfaction survey was also performed. A study approval was obtained from the institutional revision board before starting the study.ResultsOver 8 months, 72 and 66 patients during P1 and P2 were respectively included. The dynamic algorithm was more efficient, with reduced time to control hyperglycaemia (P1 vs P2:8.3 vs 5.3 hours; HR: 2.02 [1.27; 3.21]; p<0.01), increased the number of in-target BG measurements (P1 vs P2: 37.0% vs 41.8%; p<0.05), and reduced the glycaemic variability related to each patient (P1 vs P2, %CV: 40.9 vs 38.2;p<0.05, Index Correlation Class:0.30 vs 0.14; p<0.05). In patients after the first event of hypoglycemia after having started the infusion, new events were lower (P1 vs P2: 19.4 vs 11.4; p<0.001) thanks to an earlier reaction to hypoglycaemia (8.3% during P1 vs 44.3% during P2; p = 0.004). With the dynamic algorithm, the percentage of recurrence of mild hypoglycaemia was significantly lower in frail patients (20.5% vs 10.2%; p<0.001), and in patients managed in the non-expert units (18 vs 7.1%, p<0.001). The %CV was significantly improved in frail patients (36.9%). ...

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Hypoglycemia Prevention by Algorithm Design During Intravenous Insulin Infusion

Braithwaite¹,

Clark

Idrees

et al. 2018

Curr Diab Rep

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Design features that may mitigate risk for hypoglycemia include use of a mid-protocol bolus feature and establishment of a low BG threshold for temporary interruption of infusion. Computer-guided dosing may improve target attainment without exacerbating risk for hypoglycemia. Column assignment (MR) within a tabular user-interpreted algorithm or multiplier may be specified initially according to patient characteristics and medical condition with revision during treatment based on patient response. We hypothesize that a strictly increasing sigmoidal relationship between MR-dependent IR and BG may reduce risk for hypoglycemia, in comparison to a linear relationship between multiplier-dependent IR and BG. Guidelines are needed that curb excessive up-titration of MR and recommend periodic pre-emptive trials of MR reduction. Future research should foster development of recommendations for "protocol maxima" of IR appropriate to patient condition.

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Evaluation of a Nurse-Managed Insulin Infusion Protocol

Cited by 9 publications

References 21 publications

Effectiveness of blood glucose control protocol for open heart surgery patients

Effectiveness of blood glucose control protocol for open heart surgery patients

Prospective evaluation of a dynamic insulin infusion algorithm for non critically-ill diabetic patients: A before-after study

Hypoglycemia Prevention by Algorithm Design During Intravenous Insulin Infusion

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