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Computer-based Insulin Infusion Protocol Improves Glycemia Control over Manual Protocol

^a VA Tennessee Valley Health Care System, Nashville, TN
^b Vanderbilt University School of Medicine, Nashville, TN

^_* Correspondence and reprints: Jeffrey B. Boord, MD, MPH, Vanderbilt University Division of Cardiovascular Medicine, MCE South Tower Suite 5209, 1215 21^st Avenue South, Nashville, TN 37232-8802 (Email: jeffrey.boord{at}vanderbilt.edu).

Received for publication: 09/25/06; accepted for publication: 02/12/07.

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.

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