1. Carlson, Glenn MSN, RN, CCRN

Article Content


The purpose of this presentation was to show how a glycemic management protocol was changed based on current literature, patient blood glucose (BG) data, and feedback from physicians and nurses.



Glycemic management is a hot topic in critical care nursing. The groundbreaking research of Drs Furnary and VanDenBurgh showed that tight glycemic management for cardiac surgical patients lowers mortality, decreases intensive care unit length of stay, and decreases infections.



Recently, data have been published indicating that tight glycemic control may not be as good for other patient populations, specifically the neuro and medical critical care patients. This literature shows that incidence of hypoglycemia may be the etiology of worse outcomes.



An adjustment was made to the continuous insulin infusion protocol at our institution. The protocol is loosely based on the original protocol from Dr Furnary's "Portland" protocol. The clinical nurse specialist for critical care spoke to bedside nurses and the intensivists on the protocol. The clinical nurse specialist also looked at the BG data from the SICU and MICU. Changes were made based on the data and feedback from nurses and physicians. Specifically, the target was adjusted between 85 to 110 mg/dL and 100 to 130 mg/dL. Percentages of BGs were then tracked for the ranges of 70 to 130, less than 70, less than 60, less than 40, and greater than 180.



The data showed a significant decrease in incidences of BG less than 40 and decreases in BGs less than 60 and 70 respectively. There was no change in percentages of BGs outside of the target or BGs greater than 180 mg/dL.



Adjusting insulin and glycemic management protocols based on physician and nurse input and individual institution data can significantly impact the incidence of hypoglycemia. In addition, the nurses were able to do more BGs every 2 hours rather than every hour because of changes made in accounting for nursing time.


Implications for Practice:

The presentation will demonstrate an approach to improve a glycemic management protocol for the critically ill patient by decreasing hypoglycemic events and nurse workload.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.