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- Title
Impact of a Nurse Driven Subcutaneous (SQ) Insulin Treatment Algorithm for Hyperglycemia in the Emergency Department (ED).
- Authors
Munoz, Christina; Baldwin, David; Villanueva, Griselda; Agruss, Janyce; Fogg, Lou; Hannold, Katherine
- Abstract
Acute hyperglycemia is common in patients with diabetes mellitus (DM) seen in the ED. The ED setting is a prime, but often missed opportunity for clinicians to begin intensive blood glucose (BG) management. This first encounter is pivotal given that admission hyperglycemia has been correlated with subsequent inpatient morbidity and mortality. The aim of this study was to evaluate a nurse driven hyperglycemia treatment algorithm for use in the ED with the goal of improving BG level prior to admission to the hospital or discharge home from the ED. We studied the following outcomes: BG decrements, ED and hospital length of stay (LOS), and the frequency of BG <80 mg/dl. Consecutive intervention patients with a known history of DM and an ED admission BG >200 mg/dl (n= 64) were compared with a randomly selected historical control group with known DM and an ED admission BG >200 mg/dl (n= 68). ED nurses identified patients with DM, measured a point of care (POC) BG level and administered SQ insulin aspart every 2 hours as long as subsequent BG levels remained >200 mg/dl. The dosing algorithm was based on weight and the degree of BG elevation. The groups were equivalent in race and gender, but significantly differed in age and severity of admitting diagnosis. Only 31% of historical controls received insulin in the ED, while 100% of the intervention group received insulin. The intervention group achieved a statistically significant lower mean BG in the ED at the time of discharge home or admission to the hospital compared to the first POC BG taken in the ED. Intervention patients mean BG declined from 338±101 to 166±75 mg/dl and control patients BG declined from 306±117 to 234±77 mg/dl, p<.05. There was no significant difference in mean ED LOS between the two groups (intervention group 4.98 hours and control group 4.62 hours, p=.329). Mean hospital LOS in the intervention group was 4.2 days compared to 5.1 days in the control group, however this was not statistically significant after adjusting for age and severity of admission diagnosis. Post therapy BG values in 6 out of 64 intervention patients (9.4%) were less than 80 mg/dl;however, only 2 were less than 60 mg/dl, and all were treated with PO/IV glucose. These results suggest that improved BG control in the ED can be achieved in patients with DM, without significantly prolonging ED LOS, by utilizing a nurse driven treatment algorithm. The observed reduction in hospital LOS warrants additional studies with a larger sample and inclusion of cost analyses.
- Publication
Diabetes, 2007, Vol 56, pA545
- ISSN
0012-1797
- Publication type
Academic Journal