Evaluation of nursing perceptions about three insulin protocols for blood glucose control in critical care

Abstract

Introduction Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S-Skin. Methods A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be 1. Vincent JL: Give your patient a fast hug (at least) once a day.

The Effect of Computer-Assisted Glycemic Monitoring Protocol on Workload of Intensive Care Nurses

“…The computer-guided glucose management protocol that we developed is one such application. Various studies have evaluated the efficacy and safety of protocols and analyzed their effects on glycemic control [21][22][23][24] . But, studies evaluating the effect of computerized protocols on workload are limited worldwide.…”

“…The information form developed by the researchers as a result of the literature [22][23][24][25] review consists of two parts. The first part is used to collect information on the sociodemographic and occupational characteristics of the nurses, and the second part collects information on the time nurses spend measuring for the glucose follow-up.…”

“…Some parts of the protocol that were implemented in the computer program are shown in Figure 1. After reviewing the relevant literature, the questionnaire was prepared by the researchers in order to obtain the opinions of the intensive care nurses on the computerized and written glycemia protocol at the end of the study 23,24,29,30 . The questionnaire included questions which protocol for nurses is complex application, satisfied application and suitable application for intensive care unit.…”

“…Olinghouse showed that calculation of the patient's insulin dose took 30 seconds using the computerguided protocol and 2 minutes with the written protocol 22 . Studies have shown that the computer-guided protocol led to less hypoglycemia than the written protocol, which is why nurses found it safer, easier to use, and more effective compared with the written protocol 23,24 . Canbolat et al found that intensive care nurses think that computerguided glucose follow-up protocols are more effective, safer, and easier than the routine practice.…”

Prednosti in slabosti različnih protokolov vodenja vrednosti glukoze v krvi pri kritično bolnih pacientih

“…Kalfon V izvedeni raziskavi smo preverjali različne protokole vodenja vrednosti glukoze v krvi pri kritično bolnih. Več raziskav (Corrêa, et al, 2009;Okabayashi, et al, 2013;Van Herpe, et al, 2013) ugotavlja prednosti računalniško podprtih protokolov v smislu tehnoloških izboljšav, zmanjšanja delovnih obremenitev medicinskih sester in varnosti kritično bolnih pacientov, medtem ko Chant in sodelavci (2012) ugotavljajo pomen lastne strokovne presoje medicinskih sester in »ročno vodenih« protokolov. Gartemann in sodelavci (2012) navajajo, da meritve koncentracije glukoze v krvi po protokolih, ki jih izvajajo medicinske sestre, predstavljajo določeno časovno potrebo.…”