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Abstract

Introduction: Safe and effective glycemic control in the intensive care unit (ICU) is a labor intensive and challenging process. Many modalities of glucose management have been implemented to attain glycemic targets including sliding scale insulin, subcutaneous basal insulin, and insulin infusions. One of the major challenges with targeted glycemic control utilizing insulin infusions has been hypoglycemia. A new ICU insulin infusion order set was created to eliminate calculation errors, minimize user error, incorporate nutritional intake, and improve safety. Hypothesis: Implementation of a modernized continuous insulin infusion order set will reduce insulin infusion-related hypoglycemia Methods: This study incorporates a before-after study design. A baseline analysis of insulin infusion-related hypoglycemia rates was conducted in June 2011. The new insulin infusion order set was implemented in September 2011 with extensive nursing education. The retrospective analysis of safety and efficacy was conducted one month after order set implementation. It was estimated that 21 patients in each cohort would be required to achieve 80% power to determine a 25% reduction in hypoglycemia with the level of significance of 0.05. Results: A total of 47 patients with 2588 blood glucose readings and 35 patients with 1250 blood glucose readings were evaluated in June and October 2011, respectively. There was a significant reduction in percentage of hypoglycemic readings (blood glucose < 70 mg/dL) from 1.9% to 0.3%. Percent of patients with at least one hypoglycemic reading was significantly reduced from 48.9% to 5.7%. Percentage of patient days with at least one hypoglycemic reading was also significantly reduced from 16.5% to 3.6%. No significant difference in severe hypoglycemia (blood glucose < 40 mg/dL) was seen. There was a 23% increase in the percentage of readings within the desired glucose goal range with the new order set as well as a 14% reduction in the percentage of readings above the desired goal range. Conclusions: Significant improvements in insulin infusion-related hypoglycemia rates are possible when incorporating defined infusion rates, nutritional intake, and after targeted nursing educational in-services.