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.