Tiered protocol implementation improves treatment of hypoglycaemia in a neurosciences critical care and surgical intensive care unit

作者：Van Berkel Megan A; MacDermott Jennifer; Dungan Kathleen M; Cook Charles H; Murphy Claire V^*

来源：Intensive and Critical Care Nursing, 2017, 43: 6-11.

DOI：10.1016/j.iccn.2017.06.006

• Hypoglycaemia
• Glucose
• Glycaemic variability
• Protocol
• Computerised physician order entry
• Intensive care unit

Background: Although studies demonstrate techniques to limit hypoglycaemia in critically ill patients, there are limited data supporting methods to improve management of existing hypoglycaemia.
Objective: Assess the impact and sustainability of a computerised, three tiered, nurse driven protocol for hypoglycaemia treatment.
Design: Retrospective pre and post protocol study.
Setting: Neurosciences and surgical intensive care units at a tertiary academic medical centre.
Measurements: Patients with a hypoglycaemic episode were included during a pre-protocol or post protocol implementation period. An additional six-month cohort was evaluated to assess sustainability.
Results: Fifty-four patients were included for evaluation (35 pre- and 19 post-protocol); 122 patients were included in the sustainability cohort. Hypoglycaemia treatment significantly improved in the post protocol cohort (20% vs. 52.6%, p = 0.014); with additional improvement to 79.5% in the sustainability cohort. Time to follow-up blood glucose was decreased after treatment from 122 [Q1-Q3: 46-242] minutes pre-protocol to 25 [ Ql-Q3: 9-48] minutes post protocol (p < 0.0001). This reduction was maintained in the sustainability cohort [median of 29 min (Q1-Q3: 20-51)].
Conclusion: Implementation of a nurse-driven, three-tiered protocol for treatment of hypoglyacemia significantly improved treatment rates, as well as reduced time to recheck blood glucose measurement. These benefits were sustained during a six-month period after protocol implementation.

• 出版日期2017-12