1. Dillard, Cindy BSN, RN, (Student)
  2. Aragon, Daleen PhD, CCRN, FCCM (Faculty Advisor)

Article Content

Statement of the Problem: Studies have demonstrated that hyperglycemia is associated with increased mortality and morbidity in the critically ill patient. Evidence shows that blood glucose (BG) levels controlled within normoglycemic levels result in improved patient outcomes.


Purpose: Inconsistent intravenous (IV) insulin infusion orders had been used in the study facility. An evidence-based order set was developed by a Performance Improvement (PI) team for organizational use. The purpose of the project was to evaluate the safety, efficacy, and utility of the insulin infusion order set and adherence to the orders (BG monitoring, correct dosing) in critical care units in one hospital setting prior to system-wide implementation.


Significance: Hyperglycemia continues to be a common problem in acute care. Insulin is commonly used within the hospital setting to control hyperglycemia; however, the route of administration and target glucose levels remain inconsistent in intensive care unit (ICU) settings. Findings from the research literature indicate that IV insulin infusion results in more effective glycemic control in the critically ill.


Description of the practice change: Implementation of the new IV insulin infusion order set was the major practice change. Developing consistency within the organization on glycemic control was the main emphasis of the PI project (SUGAR: Systemwide Undertaking for Glycemic Achievable Results).


Evaluation: A team assembled from the PI project, including a CNS and CNS student, nurse clinician, and clinical pharmacist, was responsible for data. Data elements collected were average daily BG, time to reaching target BG, hypoglycemia events, and errors in using the order set (wrong dosing, missed BG measurements). Feedback was solicited from the ICU team regarding the use of the orders.


Implications for practice: Information gained from the pilot project will be used to determine whether changes need to be made in the order set prior to more widespread corporate implementation.