Outcomes of a Cardiothoracic Intensive Care Web-Based Online Intravenous Insulin Infusion Calculator Study at a Medical University Hospital

Abstract

We conclude that the IVIIC is a safe nurse-driven protocol with excellent BG outcomes.

Prevention of Hospital Hypoglycemia by Algorithm Design: A Programming Pathway for Electronic Order Entry

“…Computerization of intravenous insulin algorithms may be successfully accomplished either through a free standing electronic decision support system or as part of a hospital computer system (Dortch et al, 2008;Hermayer et al 2007;Junega et al, 2007). The method of computerized order entry that we will use is under construction and will not be presented here, except to say that the algorithms are related to those previously published (Bellam and Braithwaite, 2010;Devi at al, in press 2011).…”

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

“…The calculator uses the following mathematical formula: rate of insulin infusion/hour ¼ (current BG À 60 mg/dL) Â 0.03. 18,19 Additionally, the protocol requires that enough insulin be infused to address severe hyperglycemia at initiation with a rapid reduction in the insulin infusion rate as BG normalizes. The protocol also permits an adjustment of the insulin rate by tenths of a unit per hour to maintain the BG in the center of the target range.…”

“…In early 2006, all adult ICUs were using our in-house, web-based intravenous insulin infusion calculator (IVIIC), which prompted more BG readings with intensification of insulin drip use. 19 Specifically, initial monitoring for the IVIIC included BG readings every 2-4 hours. To avoid hypoglycemic events from occurring with the intensification of BG readings for the IVIIC, the BG monitoring frequency was increased to every hour in July 2006.…”

“…In July 2006, we revised the protocol using aliquots of D50% specific to the BG reading. 19 This action has resulted in decreasing the glycemic excursions observed due to overcorrection of hypoglycemia. 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).…”

Subjecting Acute Ischemic Stroke Patients to Continuous Tube Feeding and an Intensive Computerized Protocol Establishes Tight Glycemic Control

“…Besides unpredictable feeding patterns, less intensive care with a lower frequency of blood glucose assessments could also hamper TGC on a stroke unit as compared to the ICU setting. The use of a computer supported treatment protocol and increasing the rate of insulin adjustments has the potential to enhance TGC [31,32].…”