Controlling the Blood Sugars of Ventilator Dependent Patients in the ICU: Outcomes of an Interdisciplinary Evidence-Based Practice Project

2.50
Hdl Handle:
http://hdl.handle.net/10755/158977
Type:
Presentation
Title:
Controlling the Blood Sugars of Ventilator Dependent Patients in the ICU: Outcomes of an Interdisciplinary Evidence-Based Practice Project
Abstract:
Controlling the Blood Sugars of Ventilator Dependent Patients in the ICU: Outcomes of an Interdisciplinary Evidence-Based Practice Project
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2007
Author:Nass, Joyce, MSN, RN, CS, CCRN
P.I. Institution Name:BryanLGH Medical Center
Contact Address:Intensive Care, Lincoln, NE, 68506, USA
Co-Authors:J.E. Smith, Research Center, BryanLGH College of Health Sciences, Lincoln, NE
Many studies have verified the need for tight blood glucose control in hospitalized patients. Some of the most striking results have been demonstrated for patients admitted to intensive care units (ICUs). In one of the first of these studies, Van den Berghe (2001), achieved a 42% drop in ICU mortality by maintaining patients' blood glucose levels between 80-110 mg/dl. While the need for improved blood glucose control has been well established, effective methods for achieving this change have proven elusive. This study explored the impact of a multidisciplinary intervention on the blood glucose levels of ventilator dependent patients in the ICU of a Midwestern medical center. In 2004 the physician intensivists, a clinical nurse specialist (CNS), staff nurses, pharmacists and dieticians formed a team to achieve better control of blood glucose levels for ICU patients. The first step involved the institution of an IV insulin protocol for all ventilated ICU patients regardless of diabetes diagnosis. Next, the nursing staff was educated on the protocol and provided support from the CNS as they built confidence in its use. A fear of hypoglycemic episodes was encountered at this stage, however it was soon verified that hypoglycemic readings were not increased with the new protocol. The focus of the team then became quickly achieving blood glucose values within a range of 80-110 mg/dl after the initiation of therapy. Within several months the team was able to consistently bring blood glucose values under control within the first 6-12 hours of therapy. Daily multidisciplinary rounds now routinely include a discussion of each patient's blood glucose control needs and all staff members recognize their roles in this important process. The IV insulin drip protocol will now be instituted in units outside the ICU and baseline measures are planned to provide a basis for evaluating the progress of unit-based multidisciplinary blood glucose control improvement efforts. The report of the process and outcomes of this project can serve as a model for other practitioners as they strive to improve the outcomes of their patients through better blood glucose control, or as they work through other evidence-based practice changes.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleControlling the Blood Sugars of Ventilator Dependent Patients in the ICU: Outcomes of an Interdisciplinary Evidence-Based Practice Projecten_GB
dc.identifier.urihttp://hdl.handle.net/10755/158977-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Controlling the Blood Sugars of Ventilator Dependent Patients in the ICU: Outcomes of an Interdisciplinary Evidence-Based Practice Project</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Nass, Joyce, MSN, RN, CS, CCRN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">BryanLGH Medical Center</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Intensive Care, Lincoln, NE, 68506, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">jnass@bryanlgh.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">J.E. Smith, Research Center, BryanLGH College of Health Sciences, Lincoln, NE</td></tr><tr><td colspan="2" class="item-abstract">Many studies have verified the need for tight blood glucose control in hospitalized patients. Some of the most striking results have been demonstrated for patients admitted to intensive care units (ICUs). In one of the first of these studies, Van den Berghe (2001), achieved a 42% drop in ICU mortality by maintaining patients' blood glucose levels between 80-110 mg/dl. While the need for improved blood glucose control has been well established, effective methods for achieving this change have proven elusive. This study explored the impact of a multidisciplinary intervention on the blood glucose levels of ventilator dependent patients in the ICU of a Midwestern medical center. In 2004 the physician intensivists, a clinical nurse specialist (CNS), staff nurses, pharmacists and dieticians formed a team to achieve better control of blood glucose levels for ICU patients. The first step involved the institution of an IV insulin protocol for all ventilated ICU patients regardless of diabetes diagnosis. Next, the nursing staff was educated on the protocol and provided support from the CNS as they built confidence in its use. A fear of hypoglycemic episodes was encountered at this stage, however it was soon verified that hypoglycemic readings were not increased with the new protocol. The focus of the team then became quickly achieving blood glucose values within a range of 80-110 mg/dl after the initiation of therapy. Within several months the team was able to consistently bring blood glucose values under control within the first 6-12 hours of therapy. Daily multidisciplinary rounds now routinely include a discussion of each patient's blood glucose control needs and all staff members recognize their roles in this important process. The IV insulin drip protocol will now be instituted in units outside the ICU and baseline measures are planned to provide a basis for evaluating the progress of unit-based multidisciplinary blood glucose control improvement efforts. The report of the process and outcomes of this project can serve as a model for other practitioners as they strive to improve the outcomes of their patients through better blood glucose control, or as they work through other evidence-based practice changes.</td></tr></table>en_GB
dc.date.available2011-10-26T21:34:57Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T21:34:57Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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