Improving the Quality of Regular Insulin Infusion Practice

Purpose:
Purpose:To improve the quality of regular insulin infusion practice by providing a case-based interactive mandatory education session for staff nurses on medical surgical units

Significance:
Hyperglycemia in the hospitalized patient has been associated with increased incidence of infection, length of hospital stay, and increased overall mortality. Treatment of choice for hyperglycemia in some cases is regular insulin intravenous infusion with adjustments per nursing protocol.

Strategy and Implementation:
Quality indicators for regular insulin infusion were identified according to the hospital guidline: 1)BG monitoring hourly and charted in computer medication administration record (MAR) 2)Hourly dose titration charted in computer MAR 3)SQ Prandial insulin ordered for PO carbohydrate intake 4)Initiation of basal insulin if infusion rate >1 unit/hour 5)Occurrences of hypoglycemia (<70 mg/dL) while on Reg gtt An interactive case-based Turning Point lecture was presented to 500 staff nurses during annual mandatory training in October of 2010. Cases were presented highlighting common protocol deviations. An audit tool was designed to address the quality indicators as either compliant (Y) or noncompliant (N) with the guideline indicator.Hypoglycemic occurrences (defined as BG under 70 mg/dL) were reviewed and classified as to the most likely cause. Regular insulin infusion occurrances 3 months pre and post education were audited and rates of compliance were compared.

Evaluation:
Evaluation:The number of infusions audited was 135,77 defined as pre education and 58 defined as post education. Changes in the rates of compliance were assessed for significance using Fisher's exact test for dichotomous outcomes and t-tests for % of changes deviating from the protocol.

Implications for Practice:
Quality regular insulin infusion practice will be evidenced by high rates of compliance, and minimal occurrences of hypoglycemia related to protocol deviation. Staff nurse training with an interactive case based approach is an effective means of improving compliance with the protocol.