PURPOSE: Intensive glucose control in critically ill patients improves outcomes(1-3). However, there are barriers to its widespread acceptance which include inadequate knowledge of benefits, concern for hypoglycemia, and significant nursing time. In January 2004, we instituted an insulin infusion protocol in the medical ICU. This particular protocol was chosen because it is effective(4) and does not require calculations. The objective of this study was to evaluate the healthcare providers’ knowledge, attitudes, and experience with this insulin infusion protocol.
METHODS: Anonymous voluntary surveys were used to examine the opinions of ICU nurses, and Pulmonary and Critical Care physicians. The survey evaluated knowledge regarding the benefits of intensive glucose control, and opinions regarding threshold glucose values to trigger the protocol, as well as other indicators for the protocol, and hypoglycemia.
RESULTS: Ninety six percent of all surveyed were aware of the benefits of intensive glucose control. Majority of physicians stated that hyperglycemia was the key indicator to start the protocol, whereas majority of nurses indicated that the overall clinical picture was more important. While 81% of nurses and 80% of physicians noted hypoglycemia, only a minority observed a glucose level below 40. Whereas 39% of nurses believed that glucose levels >200 should trigger the protocol, 70% of physicians thought that the trigger should be >150 (p<0.05). Furthermore, the surveys elicited these concerns: the protocol does not incorporate trends in glucose levels, patient discomfort due to the frequent fingersticks and/or too many blood draws, and not enough glucometers.
CONCLUSION: Both physicians and nurses are highly knowledgeable of the benefits of intensive glucose control; however, they differ as to glucose triggers and clinical indications for the insulin infusion protocol.
CLINICAL IMPLICATIONS: Anonymous surveys can guide efforts to improve healthcare processes. Since the survey, blood conservation devices have been implemented. Also, there are initiatives to increase the availability of glucometers, and to improve Information Technology to implement a sophisticated insulin infusion protocol that incorporates glucose trends.
DISCLOSURE: Howard Saft, None.