Evaluation of nursing perceptions about three insulin protocols for blood glucose control in critical care

Introduction

In order to implement a tight glycemic control protocol in the ICU it is essential to obtain active nurse involvement. Our objective was to evaluate nurse's perception about three different blood glucose control protocols for critically ill patients.

Methods

As part of a randomized control trial (RCT) comparing three blood glucose control protocols in ICU patients, we issued a questionnaire to all nurses who participated in the study to evaluate their perception on protocol efficacy, benefits, safety, risks and feasibility and a question asking which protocol the nurses would like to be adopted in their ICU. The RCT arms were: computer-assisted insulin protocol (CAIP) with continuous insulin infusion to maintain blood glucose between 100 and 130 mg/dl; Leuven protocol with insulin infusion to maintain blood glucose between 80 and 110 mg/dl; and conventional treatment with subcutaneous insulin if glucose >150 mg/dl.

Results

Sixty nurses answered the questionnaires. CAIP was considered the most efficient by 57% of the nurses. About 58% of the nurses evaluated its performance as good or very good, compared with 22% for the Leuven protocol (P < 0.001) and 40% for conventional treatment (P = 0.08). CAIP was considered easier to use than the Leuven protocol (P < 0.001) and as easy as conventional treatment (P = 0.78). Fifty-six percent of the nurses chose CAIP as the protocol they would like to be adopted in their institution.

Conclusion

CAIP was more efficacious, safer and easier to use than the Leuven protocol. Compared with conventional treatment, the feasibility and safety of CAIP were considered similar. Most nurses chose CAIP as the protocol they would like to be adopted in their ICU.