"Spreading" of Tight Glycemic Control Utilizing Subcutaneous Insulin to the Medical Surgical Patient
Abstract Number: 2161-PO
Authors: MARY ZUGCIC, PENELOPE STRIZ, JEAN TALLEY, RAGHAVENDRAN VEMULAPALLI
Institutions: Detroit, MI
Results: Improving control of glycemia in the hospitalized patient has been shown to lower infection risk, shorten length of stay and decrease mortality in select patient populations. Literature reports improvements in the intensive care population with frequent glucose monitoring and intravenous insulin.
Henry Ford Hospital, a large urban teaching institution, achieved greater levels of glycemic control in the intensive care patient utilizing an escalating nomogram and intravenous insulin, but needed to address glycemic control in the general medical surgical patient population where intravenous insulin required frequent monitoring not available in non-ICU areas.
The subcutaneous Tight Glycemic Control (TGC) Protocol replaces the traditional sliding scale approach utilizing aspart as the rapid acting insulin. Rapid acting insulin doses are administered according to a nomogram that takes into account patient glucose levels and response to insulin therapy that is individualized for the patient by the registered nurse as determined by the protocol. The TGC protocol increased the rate of euglycemia (glucose 80-150mg/dL) in the general medical surgical patient population by 18.7% (p<.001).
Challenges that existed in the "Spread of TGC" included knowledge deficits related to newer approaches to diabetes treatment and improvements in insulin therapies, importance of tight glycemic control and concerns about hypoglycemia. It also became apparent that communication between care providers was imperative in acheiving tight glycemic control.
Implementation of the TGC protocol involved education for all involved professionals (physicians, registered nurses and pharmacists). Education content included the importance of basal and bolus insulin administration, advantages of tighter glucose control and the actions of the newer insulins. It was important to facilitate open discussion of concerns related to the protocol. Active participation of unit champions insured compliance with following the TGC protocol.