Friederike Compton is an internist, nephrologist, and intensive care specialist and is the director of the medical intensive care unit of the Department of Nephrology, Charité Campus Benjamin Franklin, Berlin, Germany.Robert Ahlborn is a biomedical engineer and is responsible for the patient data management system used in the medical intensive care unit of the Department of Nephrology, Charité Campus Benjamin Franklin.Torsten Weidehoff is a registered nurse with intensive care specialization and works in the medical intensive care unit of the Department of Nephrology, Charité Campus Benjamin Franklin.
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BackgroundInsulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy.ObjectivesTo evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload.MethodsA nurse-directed protocol for blood glucose management was developed by an interprofessional team, and the protocol's performance was investigated in 175 patients compared with 384 historical controls.ResultsWith the nurse-directed protocol, hypoglycemia incidents declined significantly (31% vs 12%, P < .001), and minimum blood glucose levels increased significantly (80 mg/dL vs 93 mg/dL, P < .001). Mean and maximum blood glucose levels, the proportion of glucose readings within the target range (31% vs 26%, P = .06), and the number of blood glucose checks (59 vs 58, P = .85) remained unchanged with use of the protocol.ConclusionImplementation of the nurse-directed protocol for blood glucose management did not increase nursing workload but reduced hypoglycemia incidents significantly while maintaining adequate glycemic control.CE 1.0 hour, CERP AThis article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives:Describe established protocols for glycemic control in the intensive care unitIdentify problems associated with glucose management protocolDiscuss advantages of nurse-directed blood glucose managementTo complete evaluation for CE contact hour(s) for activity #C1731, visit www.ccnonline.org and click the “CE Articles” button. No fee for AACN members. This CE activity expires on June 1, 2019.The American Association of Critical-Care Nurses is an accredited provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AACN has been approved as a provider of continuing education in nursing by the State Boards of Registered Nursing of California (#01036) and Louisiana (#LSBN12).