Nursing involvement improves compliance with tight blood glucose control in the trauma ICU: A prospective observational study

Summary 

Introduction

The importance of tight glycaemic control has gained acceptance over the last 5 years as a critical component of routine intensive care unit (ICU) measures. In an environment already strained for resources and staffing, however, effective strategies providing for increased input and responsibility of bedside nursing personnel are paramount to successful implementation.

Hypothesis

Increasing input and responsibilities of ICU nursing staff in tight glycaemic control policies improves glucose control in the trauma ICU.

Methods

After Institutional Review Board approval, we conducted a prospective “before-after” trial examining the effect of nursing education and input on outcome of a tight (goal 80–120mg/dL) glycaemic control protocol. After a three month assessment of compliance with a previously physician-developed protocol, an educational in-service was conducted for all trauma ICU nursing staff. Nursing staff were then asked to provide input on the development of a new protocol using multiple-choice ballots to define 7 components of protocol criteria. Using nursing input, we developed and implemented a new glycaemic protocol that shifted much of the responsibility for initiation and subsequent adjustment of insulin infusion to the bedside nurse, allowing them to more liberally utilise their bedside clinical judgment and knowledge of the specific patient.

Results

Nursing input on seven factors of protocol criteria did not differ significantly from the previously existing protocol, except with reference to nursing desire for increased responsibility in the implementation and maintenance of tight glycaemic control. After three months implementation of a new protocol developed utilising nursing input, both mean blood glucose levels achieved (137.8mg/dL vs. 128.2mg/dL, p=0.028) and time to first hourly blood glucose within goal range (<120mg/dL) was improved (36h vs. 9h). The number of hypoglycaemic (BS <60) episodes increased slightly after revision (1 event vs. 5 event), with no hypoglycaemic seizures or coma occurring during either period.

Conclusion

Nursing input and increased responsibility improved the results of a tight glycaemic control in our trauma ICU. Increasing nursing input in the development and implementation of a tight glycaemic policies can result in safe and effective improved glucose control in the trauma ICU.

Keywords: Glycaemic control, Nursing, Insulin therapy, Intensive care