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Impact of a simple computer alert on the quality of tight glycemic control
Critical Care volume 13, Article number: P123 (2009)
Tight glycemic control (TGC) in the ICU is difficult, and is associated with an increased risk of hypoglycemia . 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.
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.
The mean BG per patient, the glycemic penalty index (GPI)  and the hyperglycaemic index (HGI)  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).
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.
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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
- Blood Glucose
- Blood Glucose Level
- Level Control
- Caloric Intake