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Glycemic Control and Insulin Safety: The Impact of Computerized Intravenous Insulin Dosing

Beaumont Hospitals, Royal Oak, Michigan, Samuel.flanders{at}beaumont.edu

Rattan Juneja, MBBS, MD, MRCP

Department of Medicine, Indiana University School of Medicine, and Clarian Health, Indianapolis, Indiana

Corbin P. Roudebush, MD

Deceased

Joni Carroll, RN, CDE

Indiana University Hospital, and Clarian Health, Indianapolis, Indiana

Adam Golas, MPH

Indiana University School of Medicine, Indianapolis, Indiana

Beth L. Elias, PhD

University of Alabama School of Nursing, Birmingham, Alabama, and The Epsilon Group, Charlottesville, Virginia

The aim of this work was to evaluate our Glycemic Control Initiative that was put in place to improve blood glucose control in hyperglycemic intensive care patients and improve insulin safety by minimizing the risk of hypoglycemia. A computerized decision-support tool was developed for intravenous insulin dosing that provided an automated and standardized approach across the organization’s intensive care units (ICUs). As a result of this, at 3 years post implementation, ICU patients are 2.28 times more likely to have blood glucose levels <150 mg/dL (odds ratio = 2.28; 95% confidence interval = 2.25-2.30; P < .001) compared with the baseline period. Although glycemic control was significantly improved, the patient safety risk from hypoglycemia did not increase, as rates of blood glucose <50 mg/dL decreased from 0.68% at baseline to 0.64% in 2007. (Am J Med Qual 2009;24:489-497)

Key Words: glycemic control • intensive insulin therapy • hyperglycemia • hypoglycemia • decision support

This version was published on November 1, 2009

American Journal of Medical Quality, Vol. 24, No. 6, 489-497 (2009)
DOI: 10.1177/1062860609338406


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