Stamping Out Hypoglycemia In A Surgical Intensive Care Unit: A Multidisciplinary Approach

Context: Both hyperglycemia and hypoglycemia can significantly impact outcomes in critically ill patients. In the Intensive Care Unit (ICU), hypoglycemia is often the result of intensive insulin therapy. Aims: The purpose of this study is to assess the impact of insulin infusion associated hypoglycemia using a multidisciplinary quality improvement approach with targeted education and real-time follow-up in a surgical ICU. Setting and Design: A concurrent study in a surgical ICU of an academic medical center. Materials and Methods: Our clinical pharmacists concurrently reviewed all cases of hypoglycemia (glucose <74 mg/dL) from March 16, 2010, to March 15, 2011. For cases of hypoglycemia judged related to insulin infusions, the pharmacists and unit clinical nurse specialists reviewed each case for compliance with institutional guidelines, and unit clinical nurse specialists or nurse managers provided targeted education to the bedside nurses involved. In August 2010, we performed unit wide nursing education on glycemic control and the insulin infusion guideline. Causes of hypoglycemic events were compared before and after education was completed. Statistical Analysis: Fisher's exact test for nominal data. Results: Four hundred and twenty-nine hypoglycemic events (188 patients) occurred in 2233 patient admissions. Most events involved administration of insulin (40%), including 106 (25%) involving insulin infusions and 59 (14%) associated with sliding scale insulin administration. Education significantly reduced the percentage of hypoglycemic events due to noncompliance (47% pre vs. 17% post, P = 0.002). Conclusions: Education and unit feedback with concurrent staff follow-up were associated with a significant reduction in the rate of hypoglycemic events. The following core competencies are addressed in this article: Patient care, practice-based learning and improvement.