The benefits
of controlling blood glucose levels in intensive care units (ICUs)
are well documented. Objective: This study determined the effectiveness
and safety of a standardized transition order set for converting
a continuous insulin infusion to a subcutaneous insulin regimen
in non-cardiovascular surgery ICUs patient population. Methods: A retrospective study was conducted.
Patients presenting with diabetic ketoacidosis or hyperosmolar
hyperglycemic syndrome were excluded. One hundred patients were
included prior to and 100 patients were included after initiating
the transition order set. Blood glucose control was reviewed for
up to 72 hours following the transition. Results: A total of 115 patients were included
in data analysis: 85 prior to and 30 after transition protocol.
All patients transitioned using the protocol were transitioned
to basal insulin, compared to only 40% of the prior to protocol
group. Patients transitioned correctly per the transition order
set, “per protocol,” had 54% of blood sugars within the desired
range, no increase in hypoglycemic events, and on average 5.56
hyperglycemic events (blood glucose >180 mg/dL) per person
during the 72 hours compared to 6.68 and 9.00 for the prior to
protocol group and the “off protocol” group (transitioned different
than the protocol recommended), respectively (p= 0.05). There
were significant differences in blood sugar control at 48 and
72 hours between the “per protocol” and “off protocol” groups
(p= 0.01) and a 40% reduction in sliding scale or correctional
insulin coverage. Conclusion: The addition of basal insulin to
transition regimens resulted in fewer hyperglycemic events with
no increase in hypoglycemic events. Patients transitioned “per
protocol” had better glucose control demonstrated by: less hyperglycemic
events, lower mean blood glucose levels at 48 and 72 hours, and
lower need for correctional insulin. These findings showed benefits
of glycemic control in the ICU by following a standardized transition
protocol.
