Adherence, Safety, and Effectiveness of a Paper versus Electronic Insulin Infusion Protocol in Acute Care

2.50
Hdl Handle:
http://hdl.handle.net/10755/164094
Category:
Abstract
Type:
Presentation
Title:
Adherence, Safety, and Effectiveness of a Paper versus Electronic Insulin Infusion Protocol in Acute Care
Author(s):
Locke, Christy; McEuen, Judy; Felder, Robert; Radcliffe, LeAnn; Barrett, Thomas; Stevens, Brent; Lesselroth, Blake; Pope, Diana
Author Details:
Christy Locke, DNP, CNS, CNOR, Portland VA Medical Center, Portland, Oregon, USA, email: christine.locke@med.va.gov; Judy McEuen; Robert Felder; LeAnn Radcliffe; Thomas Barrett; Brent Stevens; Blake Lesselroth; Diana Pope
Abstract:
PURPOSE/OBJECTIVES: The purpose of this study was to validate adherence, safety and effectiveness of a paper versus electronic insulin infusion protocol (UP). SIGNIFICANCE: 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. DESIGN: This quasi-experimental study used an intervention/untreated control group design. Methods: The intervention group (IG) utilized an electronic protocol and the control group (CG) a paper protocol. Twenty-nine insulin infusions on two acute care units were evaluated. FINDINGS: 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 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, is it easy to determine 1) required adjustment (t=4.91; p=0.0001), 2) required bolus dose (t=3.l5; p=0.005), and 3) understand the protocol (t=3.65; p=0.002). CONCLUSIONS: This study demonstrates an IIP can be adhered to the 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.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2010
Conference Name:
CNS as Interal Consultant: Influencing Local to Global Systems
Conference Host:
NACNS - National Association of Clinical Nurse Specialists
Conference Location:
Portland, Oregon, USA
Description:
Conference theme: CNS as Internal Consultant: Influencing Local to Global Systems, held March 3 - 6, Portland, Oregon, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleAdherence, Safety, and Effectiveness of a Paper versus Electronic Insulin Infusion Protocol in Acute Careen_GB
dc.contributor.authorLocke, Christyen_US
dc.contributor.authorMcEuen, Judyen_US
dc.contributor.authorFelder, Roberten_US
dc.contributor.authorRadcliffe, LeAnnen_US
dc.contributor.authorBarrett, Thomasen_US
dc.contributor.authorStevens, Brenten_US
dc.contributor.authorLesselroth, Blakeen_US
dc.contributor.authorPope, Dianaen_US
dc.author.detailsChristy Locke, DNP, CNS, CNOR, Portland VA Medical Center, Portland, Oregon, USA, email: christine.locke@med.va.gov; Judy McEuen; Robert Felder; LeAnn Radcliffe; Thomas Barrett; Brent Stevens; Blake Lesselroth; Diana Popeen_US
dc.identifier.urihttp://hdl.handle.net/10755/164094-
dc.description.abstractPURPOSE/OBJECTIVES: The purpose of this study was to validate adherence, safety and effectiveness of a paper versus electronic insulin infusion protocol (UP). SIGNIFICANCE: 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. DESIGN: This quasi-experimental study used an intervention/untreated control group design. Methods: The intervention group (IG) utilized an electronic protocol and the control group (CG) a paper protocol. Twenty-nine insulin infusions on two acute care units were evaluated. FINDINGS: 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 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, is it easy to determine 1) required adjustment (t=4.91; p=0.0001), 2) required bolus dose (t=3.l5; p=0.005), and 3) understand the protocol (t=3.65; p=0.002). CONCLUSIONS: This study demonstrates an IIP can be adhered to the 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.en_GB
dc.date.available2011-10-27T11:41:55Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:41:55Z-
dc.conference.date2010en_US
dc.conference.nameCNS as Interal Consultant: Influencing Local to Global Systemsen_US
dc.conference.hostNACNS - National Association of Clinical Nurse Specialistsen_US
dc.conference.locationPortland, Oregon, USAen_US
dc.descriptionConference theme: CNS as Internal Consultant: Influencing Local to Global Systems, held March 3 - 6, Portland, Oregon, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.en_US
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