Housewide use of EndoTool ® Computer-Based IV Insulin Management Improves Glycemic Control

Purpose:
The purpose of this study was to compare glycemic control in patients managed with an algorithm-based paper IV insulin protocol (paper protocol) to those managed with a computer-based IV insulin protocol (EndoTool ®) in units outside the Intensice Care Unit (ICU).

Background/Significance:
Poor glycemic control in hospitalized patients increases mobidity and mortality, nosocomial infections, deep sternal wounds, length of stay and costs. Paper protocols have typically been used to manage blood sugar levels with varying degrees of success. More recently, ICU's have begun using computer based IV insulin protocols with success, like EndoTool ®. Consisdering the success rate in our ICU patient population, we expanded the protocol housewide.

Methods:
Blood glucose levels were retrospectively reviewed in adult patients on 4 acute care units. Blood glucose levels were compared using the paper protocol (pre- EndoTool ®), and a computer based protocol (EndoTool ®). Data includes average initial blood glucose; time in hours to blood glucose goal of <160 mg/dl; Incidence of hypoglycemia <70 mg/dl and hyperglycemia >180 mg/dl.

Results:
Prior to implementation of Endotool® (using the algorithm-based paper protocol) the percentage of hypoglycemic readings < 70 mg/dl in non-ICU patients was 2.47%, reduced to 0.96% with Endotool®. Percentage of hyperglycemia >180 mg/dl was reduced from 32.8% to 17.9%, resulting in 81% of readings in the target range of 70-180 mg/dl. After implementation in the ICU, hypoglycemia <70 mg/dl was 0.08%, hyperglycemia >180 mg/dl was 12.9%. Average time in hours to achieve glucose goal of <160 mg/dl for non-ICU patients was 1.87 hours compared to ICU patients at 2.77 hours.

Conclusions and Implications for Practice:
The incidence of hypo and hyperglycemia was achieved on all study units with Endotool®. Nurses reported increased satisfaction and reduced nursing judgement errors. EndoTool ® can successfully be implemented in non-ICU patients to achieve better glycemic control.