Computer-based Insulin Infusion Protocol Improves Glycemia Control over Manual Protocol
- Jeffrey B Boord,
- Mona Sharifi,
- Robert A Greevy,
- Marie R Griffin,
- Vivian K Lee,
- Ty A Webb,
- Michael E May,
- Lemuel R Waitman,
- Addison K May,
- Randolph A Miller
- Affiliations of the authors: VA Tennessee Valley Health Care System (JBB, RAG, MRG), Nashville, TN; Vanderbilt University School of Medicine (JBB, MS, RAG, MRG, VKL, TAW, MEM, LRW, AKM, RAM), Nashville, TN
- Correspondence and reprints: Jeffrey B. Boord, MD, MPH, Vanderbilt University Division of Cardiovascular Medicine, MCE South Tower Suite 5209, 1215 21st Avenue South, Nashville, TN 37232-8802; e-mail: <jeffrey.boord{at}vanderbilt.edu>
- Received 25 September 2006
- Accepted 12 February 2007
Abstract
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 ≥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.
Footnotes
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Research funding for collection and analysis of these data were provided in part by the Agency for Healthcare Research and Quality, Centers for Education and Research in Therapeutics cooperative agreement (grant #HS 1-0384). This work is also supported in part by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service, Target Research Enhancement Program. Dr. Boord is supported by the Office of Academic Affiliations, Department of Veterans Affairs, VA National Quality Scholars Program, and with resources and the use of facilities at VA Tennessee Valley Healthcare System. Ms. Lee and Ms. Sharifi are supported by National Library of Medicine (NIH) Training grant T15 LM07450. Dr. Miller and Dr. Waitman were supported in part by both AHRQ grant HS-1-0384 and by NIH/National Library of Medicine grant 1R01-LM007995. Dr. Michael May was supported in part by NIH grant U01-DK30620. The authors had sole responsibility for design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of the manuscript.
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We thank Xulei Liu, MS, for aid in data analysis and Pat Gideon, RN, for assistance with chart data collection. We also acknowledge the assistance of Asli Ozdas, PhD, in collecting data for the study; Gwen Holder, RN, Devin Carr, RN, and Richard Benoit, RN, for assistance in conducting the study (training of participants, assistance with software and hardware installation, problem-solving and trouble-shooting during study); and members of the Vanderbilt CPOE team for help with development and deployment of the system.
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While Vanderbilt University has commercialized its CPOE system through licensing it to a vendor, the pre-commercialization version of the software was used in the study. The authors have fully disclosed to the JAMIA Acting Editor-in-Chief and to reviewers all relevant materials regarding lack of conflict of interest. Care has been taken that the first author, statistician, and key members of the design and implementation teams were wholly unaffected by, and not involved in, the commercialization of or royalties from the Vanderbilt CPOE system.
