1. Locke, Christy DNP, CNS, CNOR
  2. Mceuen, Judy BSN, RN, CDE
  3. Felder, Robert DDS, MPH
  4. Radcliffe, Leann MD, MCR
  5. Barrett, Thomas MD, MCR
  6. Stevens, Brent RN
  7. Lesselroth, Blake MD, MBI
  8. Pope, Diana RN, PhD

Article Content


The purpose of this study was to validate adherence, safety, and effectiveness of a paper versus electronic insulin infusion protocol (IIP).



Several national organizations promote glucose control (GC) as an indicator of safe, quality care. National guidelines recommend the use of insulin infusion to achieve GC. An American Diabetes Association consensus statement identifies protocol use as burdensome and a barrier to GC. Other organizations recommend protocol use to optimize provider abilities and reduce errors. Before evaluating glucose outcomes associated with IIP use, it is important to first validate protocol adherence. Additionally, protocol use is recognized as burdensome; therefore, understanding nurses' perceptions are important.



This quasi-experimental study used an intervention/untreated control group design.



The intervention group (IG) utilized an electronic protocol, and the control group (CG) utilized a paper protocol. Twenty-nine insulin infusions on 2 acute care units were evaluated.



89.7% (n = 26) of all infusions had a median time from capillary blood glucose (CBG) acquisition to infusion device adjustment of 10 minutes or less. Median times for adjustment did not significantly differ between groups (P = 0.113). 96.6% (n = 28) of all infusions had a median CBG acquisition time within the acceptable range. Median values of time to "next due" did not significantly differ between groups (P = 0.88). 10.7% (n = 94) of all CG rate adjustment calculations were incorrect. Errors (N = 168) such as CBG transcription and pump programming errors were 14% lower in the IG (P = 0.563). Groups did not significantly differ in areas of satisfaction, except the IG reported it was easier to balance the protocol with their workload than the CG (t = -2.21, P = 0.03). Significant differences existed within the IG between the pretest (paper) and posttest (electronic) conditions when RNs were asked if it is easy to (1) determine the required adjustment (t = 4.91, P = 0.0001), (2) determine the required bolus dose (t = 3.15, P = 0.005), and (3) understand the protocol (t = 3.65, P = 0.002).



This study demonstrates that an IIP can be adhered to majority of the time regardless of the platform (paper/electronic).


Implications for Practice:

There were fewer errors with the electronic protocol, and nurses who switched from paper to electronic (IG) were more satisfied with the electronic protocol.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those 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 for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.