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A computer-based intravenous protocol can improve glycemic control in surgical ICU patients

Hyperglycemia (excessively high blood sugar levels) increases the risk of surgical site infections, leading to longer hospital stays and other problems. Therefore, precise glycemic control is recommended in surgical intensive care unit (SICU) patients. However, intravenous insulin protocols for strict glycemic control are complex, requiring frequent bedside glucose monitoring and repeated intricate calculations to titrate insulin doses. Standardized, nurse-managed, paper-based intravenous insulin protocols do not always produce optimal results.

A computer-based insulin infusion protocol improves glycemic control in SICU patients over a manual protocol, according to a new study. Researchers compared this manual approach with computer-based protocols that were integrated into a computerized provider order entry (CPOE) system, which was already being used by clinicians to manage their patients. The researchers reviewed glycemic control of adult patients admitted to an SICU during a 32-day manual protocol period, and later, during a 49-day computer-based protocol period. They found that the computer-based protocol reduced time from first glucose measurement to initiation of insulin protocol, improved the percentage of all SICU glucose readings in the ideal range, and improved control in patients on intravenous insulin for 24 hours or more. Hypoglycemia (excessively low blood sugar levels, less than 40 mg/dl) was rare in both groups.

The study was supported in part by the Agency for Healthcare Research and Quality (HS10384).

See "Computer-based insulin infusion protocol improves glycemia control over manual protocol," by Jeffrey B. Boord, M.D., M.P.H., Mona Sharifi, Robert A. Greevy, Ph.D., and others, in the May/June 2007 Journal of the American Medical Informatics Association 14, pp. 278-287.

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