0
Abstract: Slide Presentations |

CREATION AND REFINEMENT OF A COMPUTERIZED INSULIN INFUSION PROTOCOL FOR CONTROLLING BLOOD SUGARS IN BOTH ADULT AND PEDIATRIC CRITICALLY ILL PATIENTS FREE TO VIEW

Ellie L. Hirshberg, MD*; Gitte Larsen, MD, MPH; Kathy Sward, PhD; Dean Sorenson, PhD; Vijay Srinivasan, MD; Arno Zaritsky, MD; Neal Thomas, MD; Alan Morris, MD; James Orme, MD
Author and Funding Information

University of Utah, Salt Lake City, UT



Chest. 2006;130(4_MeetingAbstracts):148S. doi:10.1378/chest.130.4_MeetingAbstracts.148S-c
Text Size: A A A
Published online

Abstract

PURPOSE: Treatment protocols and guidelines are essential tools to decrease medical errors and improve care in an Intensive Care Unit (ICU) setting. Control of hyperglycemia is a goal in most adult and an increasing number of pediatric ICUs. The goal of glucose control provides an opportunity to create a decision support tool common to both adults and children. A computerized insulin protocol can provide explicit and non-ambiguous instructions for titrating insulin and controlling hyperglycemia. We describe the development, refinement, and validation of an insulin infusion computerized protocol (eProtocol_insulin) for blood sugar control in adult and pediatric ICU patients.

METHODS: The rules for each protocol version were analyzed and discussed by the computer protocol development research group at LDS Hospital. Insulin protocol rules were initially developed and extensively tested for adult patients. Weight adjustment of the adult protocol created the pediatric version. Each version was tested against possible clinical scenarios and different patient weights. The logic and acceptability of the clinical instructions were reviewed by each member of the development research group to determine feasibility and safety of the instruction. The program was then placed in a pediatric ICU (PICU) clinical environment with onsite physician/developer oversight. In addition 5 PICU clinicians were surveyed to independently provide their own set of insulin titration instructions for a set of 193 clinical scenarios. The clinicians' instructions were then compared to the eProtocol_insulin instructions.

RESULTS: Comparing eProtocol_insulin adults vs. pediatrics: measurements (adults 19,849 vs. peds 2,234), average glucose•SD (113•40 vs. 121•57), % measurements < 60 mg/dl (1.22%, vs. 0.72%), % measurements • 40 mg/dl (0.1% vs. 0.04%), compliance with instructions (95% vs. 89%).

CONCLUSION: Careful development with batch testing and supervised controlled clinical experience allowed safe and effective refinement of a computerized insulin infusion protocol for glucose control in both adult and pediatric ICUs.

CLINICAL IMPLICATIONS: Computerized protocol's can provide a framework for standardizing and improving care in both pediatric and adult critical care settings.

DISCLOSURE: Ellie Hirshberg, None.

Wednesday, October 25, 2006

10:30 AM - 12:00 PM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543