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DIMPLE DILKHUSH, PHARM.D., is Clinical Coordinator and JEFFRY LANNIGAN, PHARM.D., is Director, Department of Pharmacy, Bayfront Medical Center (BMC), St. Petersburg, FL. TRESSA PEDROFF, M.S.N., is Adjunct Faculty, University of Tampa, Tampa, FL; at the time of this project she was Clinical Nurse Specialist, Surgical Intensive Care Unit, BMC. ANTHIE RIDDLE, B.S.N., is Critical Care Nurse, BMC. MARY TITTLE, PH.D. in Nursing, is Faculty, Saint Petersburg College, St. Petersburg.

Address correspondence to Dr. Dilkhush at the Pharmacy Department, Bayfront Medical Center, 701 6th Street South, St. Petersburg, FL 33701 (dimple.dilkhush{at}bayfront.org).

Purpose. An insulin infusion protocol for critical care units is described. Summary. Evidence that aggressive glycemic control improves outcomes led physicians, nurses, dietitians, and pharmacists at a trauma center to develop an insulin infusion protocol. Before the protocol, elevated blood glucose concentrations were often not treated until they reached 200 mg/dL or higher. Insulin infusions were underutilized and were often not started until capillary blood glucose concentrations were greater than 350 mg/dL for 12 or more hours. When orders for an insulin infusion were written, they did not include directions for dosage adjustment, and the goal blood glucose range varied. A preliminary protocol was drafted allowing adjustments in insulin administration to be based on changes in capillary blood glucose values since the previous blood glucose measurement. The protocol was presented to a multidisciplinary team and further refined. The targeted blood glucose concentration range was 80–130 mg/dL. After the targeted range was achieved for a patient, if the blood glucose level continued to decrease over three consecutive measurements, the infusion rate was decreased by 0.5 or 1 unit/hr, depending on the capillary blood glucose level. Data for the first 30 patients were collected from September 2003 to August 2004. It took 2–36 hours (mean, 12.6 hours) to bring the capillary blood glucose concentration to less than 130 mg/dL. Among 2845 capillary blood glucose measurements, there were 15 cases of hypoglycemia (0.4%) requiring treatment with 50% dextrose injection. Conclusion. A multidisciplinary effort resulted in the development of an insulin infusion protocol for use in critical care units. Index terms: Caloric agents; Critical care; Dextrose; Dosage; Drug administration rate; Hypoglycemia; Insulin; Insulins; Protocols; Toxicity

 

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