Computer-based Insulin Infusion Protocol Improves Glycemia Control over Manual Protocol
Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an...
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| Published in | Journal of the American Medical Informatics Association : JAMIA Vol. 14; no. 3; pp. 278 - 287 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Inc
01.05.2007
American Medical Informatics Association |
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| Abstract | Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an intravenous insulin protocol integrated into a care provider order entry (CPOE) system.
Retrospective before-after study of consecutive adult patients admitted to a SICU during pre (manual protocol, 32 days) and post (computer-based protocol, 49 days) periods.
Percentage of glucose readings in ideal range of 70–109 mg/dl, and minutes spent in ideal range of control during the first 5 days of SICU stay.
The computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on IV insulin for ≥24 hours. Hypoglycemia (<40 mg/dl) was rare in both groups.
The CPOE-based intravenous insulin protocol improved glycemia control in SICU patients compared to a previous manual protocol, and reduced time to insulin therapy initiation. Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in SICU patients. |
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| AbstractList | Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an intravenous insulin protocol integrated into a care provider order entry (CPOE) system.
Retrospective before-after study of consecutive adult patients admitted to a SICU during pre (manual protocol, 32 days) and post (computer-based protocol, 49 days) periods.
Percentage of glucose readings in ideal range of 70–109 mg/dl, and minutes spent in ideal range of control during the first 5 days of SICU stay.
The computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on IV insulin for ≥24 hours. Hypoglycemia (<40 mg/dl) was rare in both groups.
The CPOE-based intravenous insulin protocol improved glycemia control in SICU patients compared to a previous manual protocol, and reduced time to insulin therapy initiation. Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in SICU patients. OBJECTIVE: Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an intravenous insulin protocol integrated into a care provider order entry (CPOE) system. DESIGN: Retrospective before-after study of consecutive adult patients admitted to a SICU during pre (manual protocol, 32 days) and post (computer-based protocol, 49 days) periods. MEASUREMENTS: Percentage of glucose readings in ideal range of 70-109 mg/dl, and minutes spent in ideal range of control during the first 5 days of SICU stay. RESULTS: The computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on IV insulin for greater than or equal to 24 hours. Hypoglycemia (<40 mg/dl) was rare in both groups. CONCLUSION: The CPOE-based intravenous insulin protocol improved glycemia control in SICU patients compared to a previous manual protocol, and reduced time to insulin therapy initiation. Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in SICU patients. OBJECTIVEHyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an intravenous insulin protocol integrated into a care provider order entry (CPOE) system.DESIGNRetrospective before-after study of consecutive adult patients admitted to a SICU during pre (manual protocol, 32 days) and post (computer-based protocol, 49 days) periods.MEASUREMENTSPercentage of glucose readings in ideal range of 70-109 mg/dl, and minutes spent in ideal range of control during the first 5 days of SICU stay.RESULTSThe computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on IV insulin for > or =24 hours. Hypoglycemia (<40 mg/dl) was rare in both groups.CONCLUSIONThe CPOE-based intravenous insulin protocol improved glycemia control in SICU patients compared to a previous manual protocol, and reduced time to insulin therapy initiation. Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in SICU patients. Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we could improve glycemia control over a previous paper-based, manual protocol, authors implemented, in a surgical intensive care unit (SICU), an intravenous insulin protocol integrated into a care provider order entry (CPOE) system. Retrospective before-after study of consecutive adult patients admitted to a SICU during pre (manual protocol, 32 days) and post (computer-based protocol, 49 days) periods. Percentage of glucose readings in ideal range of 70-109 mg/dl, and minutes spent in ideal range of control during the first 5 days of SICU stay. The computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on IV insulin for > or =24 hours. Hypoglycemia (<40 mg/dl) was rare in both groups. The CPOE-based intravenous insulin protocol improved glycemia control in SICU patients compared to a previous manual protocol, and reduced time to insulin therapy initiation. Integrating a computer-based insulin protocol into a CPOE system achieved efficient, safe, and effective glycemia control in SICU patients. |
| Author | Boord, Jeffrey B. May, Addison K. Miller, Randolph A. Waitman, Lemuel R. Greevy, Robert A. Sharifi, Mona Lee, Vivian K. Webb, Ty A. May, Michael E. Griffin, Marie R. |
| AuthorAffiliation | b Vanderbilt University School of Medicine, Nashville, TN a VA Tennessee Valley Health Care System, Nashville, TN |
| AuthorAffiliation_xml | – name: a VA Tennessee Valley Health Care System, Nashville, TN – name: b Vanderbilt University School of Medicine, Nashville, TN |
| Author_xml | – sequence: 1 givenname: Jeffrey B. surname: Boord fullname: Boord, Jeffrey B. email: jeffrey.boord@vanderbilt.edu organization: VA Tennessee Valley Health Care System, Nashville, TN – sequence: 2 givenname: Mona surname: Sharifi fullname: Sharifi, Mona organization: Vanderbilt University School of Medicine, Nashville, TN – sequence: 3 givenname: Robert A. surname: Greevy fullname: Greevy, Robert A. organization: VA Tennessee Valley Health Care System, Nashville, TN – sequence: 4 givenname: Marie R. surname: Griffin fullname: Griffin, Marie R. organization: VA Tennessee Valley Health Care System, Nashville, TN – sequence: 5 givenname: Vivian K. surname: Lee fullname: Lee, Vivian K. organization: Vanderbilt University School of Medicine, Nashville, TN – sequence: 6 givenname: Ty A. surname: Webb fullname: Webb, Ty A. organization: Vanderbilt University School of Medicine, Nashville, TN – sequence: 7 givenname: Michael E. surname: May fullname: May, Michael E. organization: Vanderbilt University School of Medicine, Nashville, TN – sequence: 8 givenname: Lemuel R. surname: Waitman fullname: Waitman, Lemuel R. organization: Vanderbilt University School of Medicine, Nashville, TN – sequence: 9 givenname: Addison K. surname: May fullname: May, Addison K. organization: Vanderbilt University School of Medicine, Nashville, TN – sequence: 10 givenname: Randolph A. surname: Miller fullname: Miller, Randolph A. organization: Vanderbilt University School of Medicine, Nashville, TN |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/17329722$$D View this record in MEDLINE/PubMed |
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| Snippet | Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine if we... OBJECTIVE: Hyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To... OBJECTIVEHyperglycemia worsens clinical outcomes in critically ill patients. Precise glycemia control using intravenous insulin improves outcomes. To determine... |
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| SubjectTerms | Blood Glucose - metabolism Critical Illness - therapy Drug Therapy, Computer-Assisted Female Humans Hyperglycemia - drug therapy Hypoglycemic Agents - administration & dosage Infusions, Intravenous Insulin - administration & dosage Intensive Care Units Male Medical Order Entry Systems Middle Aged Research Paper Retrospective Studies Systems Integration User-Computer Interface |
| Title | Computer-based Insulin Infusion Protocol Improves Glycemia Control over Manual Protocol |
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