The practice of glycaemic control in intensive care units: A multicentre survey of nursing and medical professionals

Abstract

Aims and objectives To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. Background Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. Design Cross-sectional, multi-centre, survey based study. Methods An online, short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia, and deviations from protocols' instructions. STROBE reporting guidelines were followed. Results Over half of the 40 respondents opined that a patient spending <75% admission time within the target glycaemic levels constituted poor glycaemic control. Professionals with more than five years' experience were more likely to rate a patient spending 50-74% admission time within target glycaemic levels as poor than less experienced colleagues. Physicians were more likely to rate a patient spending <50% admission time within target as poor than nurses. There was general agreement on how professionals would rate most deviations from their protocols. Nurses were more likely to rate insulin infusions restarted late and incorrect dosage of rescue glucose as major deviations than physicians. Most professionals agreed on when they would treat hypoglycaemia.

Effectiveness of blood glucose control protocol for open heart surgery patients

“…(2011) recommended setting a higher BG target level to prevent hypoglycaemia because patients can experience hypoglycaemia more than once if the target level of BG is set at 80–110 mg/dl. Previous studies found strong correlation between the frequency of hypoglycaemia and length of ICU confinement and emphasized that medical staff should prioritize minimizing the occurrence of hypoglycaemia in controlling BG in critical care (Fernández‐Méndez et al., 2019; Krinsley et al., 2011). A previous finding that a target level of 180 mg/dl led to lower frequency of hypoglycaemia than that of 120 mg/dl (Jacobi et al., 2012; Lazar et al., 2011) is consistent with this study where the BG target level was set at 100–180 mg/dl.…”

“…Intensive care units develop their own protocols for BG control which differ from one another (Fernández-Méndez et al, 2019;Niven et al, 2015;Orban et al, 2013). Controlling BG safely is fundamental to regulating hyperglycaemia in ICU patients.…”

“…If these conditions were met, nurses would enable safe BG control for critical patients by applying insulin injection on a timely basis according to the BG control protocol when BG exceeds the target level (Fernández-Méndez et al, 2019;Marvin et al, 2013).…”

“…It is thus necessary to develop and evaluate a protocol which is appropriate for heart surgery patients, convenient for nurses to apply and can be easily communicated among healthcare providers, with the objective of safe BG control for critically ill patients. If these conditions were met, nurses would enable safe BG control for critical patients by applying insulin injection on a timely basis according to the BG control protocol when BG exceeds the target level (Fernández‐Méndez et al., 2019; Marvin et al., 2013).…”

Staff knowledge, attitudes and practices regarding glycaemic management in adult intensive care units: A national survey

“…12 Limited studies among ICU professionals have explored the KAP of physicians and nurses regarding glycaemic control. In 2019, Fernandez-Mendez 13 conducted a survey on the views of ICU nurses and physicians on glycaemic control and found that ICU professionals often have different views on glycaemic control, which can affect their clinical practice. They confirmed protocol-practice gaps regarding glycaemic control in the critical care field, but they only focus on professionals' awareness and attitudes, with a lack of investigation on the knowledge and practice behaviour for glycaemic control.…”