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RRP 07-341 – HSR&D Study

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RRP 07-341
Glycemic Management Using an Insulin Infusion Protocol in a Non-ICU Area
Diana S. Pope PhD MS BS
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: September 2007 - August 2008

BACKGROUND/RATIONALE:
In 2007, 40.7 million inpatient days were incurred by people with diabetes and 24.3 million were attributed to diabetes care. Glucose control is an indicator of quality care. Insulin infusion is a recommended method to achieve glucose control in acute care. Protocol use can optimize healthcare provider abilities and reduce errors. The purpose of this study was to validate protocol adherence, safety and effectiveness of a paper-based Insulin Infusion Protocol (IIP) compared to an electronic IIP.

OBJECTIVE(S):
The study aims were to: (a) describe adherence between paper and electronic IIPs, (b) evaluate the amount of time required to acquire and report capillary blood glucose (CBG) values, (c) determine the calculation adjustment error rate, and (d) determine RN satisfaction.

METHODS:
This quasi-experimental study used an intervention/untreated control group design to evaluate 29 insulin infusions on 2 acute care units. Twenty-three RNs from the electronic unit and 25 RNs from the paper unit participated.

FINDINGS/RESULTS:
The majority (89.7%) of infusions had a median adjustment time of 10 minutes or less. Median times from CBG to rate adjustment did not significantly differ between groups (p=0.113). Nearly all (96.6%) infusions had median CBG acquisition times within the acceptable range (15 minutes early to 10 minutes late). Median values of time to next "CBG due" did not significantly differ between groups (p=0.88). Calculation adjustment errors were made in 10.7% (n= 94) of all paper entries. Significant differences existed in the electronic group between the pretest (paper) and posttest (electronic) conditions when RNs were asked is it easy to (a) determine the required adjustment (p=0.0001), (b) determine the required bolus insulin dose (p=0.005), and (c) understand the IIP (p=0.002). RNs using the electronic IIP reported the IIP was: (a) not more difficult than the paper IIP (68%; n=15) and (b) was easier to balance with their workload than using the paper IIP (p=0.03). Other errors such as transcription and pump programming errors (N=168) were 14% lower in the electronic group than the paper group (p=0.563).

IMPACT:
By examining IIP adherence and satisfaction, this study determined that an IIP can be adhered to regardless of the platform (paper/electronic). However, nurses who switched from paper to electronic were more satisfied with the electronic IIP and the use of an electronic IIP produced fewer errors. Glucose control improves patient outcomes. Insulin infusion is a method to achieve control. These findings support increased use of IIPs in acute care settings.

PUBLICATIONS:

Journal Articles

  1. Locke C, McEuen J, Felder RS, Lesselroth B, Barrett TW, Stevens B, Pope DS. Evaluating an insulin infusion protocol in an acute care setting. Clinical Nurse Specialist Cns. 2011 Sep 1; 25(5):237-43.
Conference Presentations

  1. Locke CL, McEuen J, Felder RS, Lesselroth B, Barrett TW, Stevens B, Pope DS. Adherence, Safety, and Effectiveness of a Paper Versus Electronic Insulin Infusion Protocol in Acute Care. Poster session presented at: National Association of Clinical Nurse Specialists Annual Conference; 2010 Mar 5; Portland, OR.


DRA: Health Systems
DRE: Treatment - Observational
Keywords: Nursing, Practice patterns
MeSH Terms: none

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