1. Klinkner, Gwen MS, RN, ADMCNS-BC, CDE

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The purpose of this clinical improvement project was to design and implement an insulin infusion algorithm to improve glycemic control and nursing adherence to the algorithm, thereby increasing patient safety. The resulting algorithm was more complex than the previous protocol but also more flexible to meet the rapidly changing needs of patients.



Tight glycemic control has been shown to improve clinical outcomes related to wound healing, infection rates, length of stay, and mortality rates. The use of standardized insulin infusion protocols or algorithms has been endorsed by the American College of Endocrinology and American Diabetes Association as an approach to manage hyperglycemia.



There has been long-standing acceptance of using insulin infusions to manage hyperglycemia throughout the institution in both critical care and acute care units. A chart review supported anecdotal reports of the ineffectiveness of the current insulin infusion protocol. This situation resulted in nurses "working around" the protocol to manage patients more effectively and to lessen the incidence of hypoglycemia.



A clinical nurse specialist-led team reviewed existing protocols before designing a pilot algorithm and associated orders and documentation tool. The algorithm, orders, and documentation tool were initially piloted on a surgical unit. The algorithm was revised based on outcomes and subsequently piloted on 3 medicine units before hospitalwide implementation.



Initial findings reveal success of the algorithm on pilot units in terms of nursing adherence to the algorithm and glycemic control. Additional findings will be available after implementation is completed in the fall of 2008.



It can be concluded, even at this early stage of implementation, that despite the complexity of the algorithm, nurses on pilot units report that it is intuitive and effective. Additional conclusions will be offered after implementation is completed in the fall of 2008.


Implications for Practice:

The clinical nurse specialist as change agent is well positioned to improve the diabetes care provided to hospitalized patients. Insulin infusions can be well managed by nurses outside of intensive care units. Designing an insulin infusion algorithm or protocol that minimizes the incidence of hypoglycemia is critical to the success of the algorithm.


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.