Improving Hyperglycemia in the Hospital: Outcomes of a Nursing In-Service to Evaluate Acceptance of a Web-Based Insulin Infusion Calculator

Abstract

Abbreviations: (ADA) American Diabetes Association, (BG) blood glucose, (CDE) certified diabetes educator, (CTICU) cardiothoracic intensive care unit, (D50W) 50% dextrose in water, (DKA) diabetic ketoacidosis, (HDTF) hospital diabetes task force, (HHNK) hyperglycemic hyperosmolar nonketotic coma, (HTML) hypertext markup language, (ICU) intensive care unit, (IV) intravenous, (IVI) intravenous insulin, (IVIIC) intravenous insulin infusion calculator, (IVP) intravenous push, (MAR) medication administration record,

Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification

“…More than 85% of the registered nurses appreciated the ability to make changes to the IVIIC at their level of practice. 9 The savings to our institution was estimated at over $100,000 annually in 2006 based on approximately 100 patients monthly on an IV insulin drip. Currently, we average about 200 IV insulin drips monthly at our institution, including the operating room, recovery room, medical-surgical floors and in the ICUs.…”

Failure to Control Hyperglycemia in NonCritically Ill Diabetes Patients despite Standard Glycemic Management in a Hospital Setting

“…Educational training should lead to adequate insulin adjustments in response to previous BG values and individual targets so as to improve glycemic management. 15,22,25,26 Electronic decision support systems could also help to achieve a structured treatment protocol. New supportive technologies can make glycemic management processes more effective by reducing prescription errors, thereby increasing effective insulin use, and minimizing the length of patients' stays.…”

Impact of improvement efforts on glycemic control and hypoglycemia at a University Medical Center

“…BG target ranges to match the level of care are as follows: intensive care unit (80-110 mg/dL); labor and delivery (70-110 mg/dL); adult medical/surgical floors (80-140 mg/dL); diabetic ketoacidosis (DKA)/hyperosmolar nonketotic coma (HHNK) (150-200 mg/dL); neurosurgery ICU (90-120 mg/dL); and perioperative patients (140-180 mg/ dL). 20 These BG targets were created to satisfy the clinical requests of specific departments at MUSC. We have restricted starting the multiplier for DKA/HHNK at 0.01, to affect a slower rate of change and the multiplier for all others is set at 0.03.…”