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Impact of a simple computer alert on the quality of tight glycemic control

Introduction

Tight glycemic control (TGC) in the ICU is difficult, and is associated with an increased risk of hypoglycemia [1]. We use a nurse-wise insulin titration protocol for TGC in our ICU. The purpose of this study was to examine the impact of a simple computer alert on the quality of TGC.

Methods

An alert was created with the EventManager® of MetaVision®. The nurses received a pop-up message on the bedside workstation, with a simple suggestion for the timing of the next measurement and a nonspecific instruction to check caloric intake and insulin dose, at the following blood glucose (BG) thresholds: BG >180 mg/dl, >110 mg/dl, <80 mg/dl, <60 mg/dl. When BG was <40 mg/dl, an alert was sent to all workstations, and to both doctors and nurses. The alert was implemented on 1 August 2007. We performed an observational cohort study, including all adults (>18 years) who were in our ICU between 31 January and 31 July 2007 (control group, n = 731), and between 31 August 2007 and 6 February 2008 (alert group, n = 654). StatView® was used for statistical analysis.

Results

The mean BG per patient, the glycemic penalty index (GPI) [2] and the hyperglycaemic index (HGI) [3] were significantly lower after implementation of the alert. There were fewer patients in the alert group who experienced at least one episode of BG <40 mg/dl. The amount of BG samples drawn per patient was similar in both groups (Table 1).

Table 1 abstract P123

Conclusion

Even in an environment where TGC is performed well, a simple computer alert can further improve BG level control and reduce the risk of hypoglycemia, without increasing the BG sample rate.

References

  1. 1.

    Berghe G, et al.: Intensive insulin therapy in critically ill patients. N Engl J Med 2001, 345: 1359-1367. 10.1056/NEJMoa011300

  2. 2.

    Van Herpe T, et al.: Glycemic penalty index for adequately assessing and comparing different blood glucose control algorithms. Crit Care 2008, 12: R24. 10.1186/cc6800

  3. 3.

    Vogelzang M, et al.: Hyperglycaemic index as a tool to assess glucose control: a retrospective study. Crit Care 2004, 8: R122-R127. 10.1186/cc2840

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Stichele, E.V., De Becker, W., Wouters, P. et al. Impact of a simple computer alert on the quality of tight glycemic control. Crit Care 13, P123 (2009). https://doi.org/10.1186/cc7287

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Keywords

  • Blood Glucose
  • Blood Glucose Level
  • Hypoglycemia
  • Level Control
  • Caloric Intake