Improved Glucose Control: a Cardiac Surgery ICU's Pre- and Post-Education Intervention Approach to Improving Compliance

Purpose:
Registered Nurse (RN) staff would verbalize the rationale for post-operative glucose control and complications of poor control; demonstrate increased compliance with following the ICU Insulin Infusion Protocol; and prevent patient complications associated with hypo- and hyperglycemia

Significance:
ICU Quality Coaches found the unit had room to improve in following the ICU Insulin Infusion protocol in 9 out of 10 hypoglycemia events. Evidence in literature demonstrated that blood glucose of 200 or more for more than two hours could increase infection risk 10 times.

Strategy and Implementation:
The ICU Quality Coaches completed 23 retrospective patient chart reviews to establish a unit baseline. The Quality Coaches presented education about the importance of glycemic control, consequences of poor control, and case studies for application at the unit's Professional Development Days. After the education, the coaches completed 31 retrospective chart reviews. Nursing staff were updated on progress in the unit newsletter, and the Quality Coaches provided one-on-one education and follow-up with RN's. The Quality Coaches now review charts and provide updates quarterly.

Evaluation:
The pre-education chart review revealed the unit's RN's were following the protocol 51% of the time. After education, compliance increased to 72% and 82% respectively in August and November 2010. The number of hypoglycemia events decreased from 17 pre-education to 11 post-education, then to 5.

Implications for Practice:
Pre- and post-education chart reviews showed increased knowledge and application of the protocol and decreased episodes of hypoglycemia. RN's also began utilizing the Quality Coaches for protocol questions and feedback.