In 2006, glycemic control at Holy Cross was governed by a linear paper protocol, like the Yale Protocol. This approach proved inefficient for the complex needs of patients in the cardiovascular ICU and operating rooms, particularly those undergoing open heart surgeries.

A breakthrough came with the introduction of EndoTool®, the only patient-specific insulin dosing software platform. The initiative was led by the Clinical Nurse Specialist (CNS) and a physician team, who sought a solution to enhance glucose management and patient outcomes. Tracey Melhuish, then a Clinical Practice Specialist, played a crucial role in evaluating and implementing this new clinical decision support technology in 2006.

The goal was not just to find a new system, but to transform how they managed glucose levels in their most critical patients. EndoTool offered a level of precision and support that had been lacking. The team assessed various software options before selecting EndoTool for its proven track record of having the lowest hypoglycemia rates and its extensive support services.

“EndoTool stood out because it wasn't just a software solution; it was a partner in improving patient outcomes. The support from Monarch’s team was unparalleled.”

Tracey Melhuish, RN, MSN, CCRN

Clinical Practice Specialist Critical Care

A journey that started with the goal of improving glucose management for critically ill patients, led to an 18-year partnership with EndoTool.

Planning and Support are Crucial for Successful Implementation

When transitioning from a paper-based system to a computerized insulin dosing tool, evaluate available options and select a system that not only meets clinical needs but also provides robust support and training. The Monarch Team’s comprehensive support, including on-site training and 24/7 assistance, played a significant role in the successful implementation of EndoTool at Holy Cross.

Expand Usage Based on Observed Benefits and Data

Start with a targeted application and expand as you observe positive outcomes and identify additional opportunities. Initially implemented for CABG patients, EndoTool demonstrated significant benefits such as lower hypoglycemia rates and faster patient recovery. Recognizing these advantages led to its broader application across all critical care units and emergency departments.

Continuous Feedback for Optimized Performance

High engagement from nursing staff and ongoing evaluation of EndoTool’s performance proved vital for maintaining its effectiveness. Regular touch points with the Monarch team helped optimize EndoTool at Holy Cross and ensures it remains effective and user-friendly.

As the benefits of EndoTool became evident, its use expanded to other areas throughout the hospital, including targeted temperature management (TTM) and diabetic ketoacidosis (DKA) patients where they saw dramatic improvements in patient outcomes.

The consistent year-on-year decrease in hypoglycemia rates, with nearly zero cases of severe hypoglycemia, underscores the success of EndoTool in enhancing patient outcomes at Holy Cross.

Incorporating EndoTool into critical care units greatly improved management of glycemic control for the patients. Previously, endocrinologists were frequently consulted, and managing insulin adjustments was a challenge.

“EndoTool is user-friendly and helps us remain stress-free in critical situations.”

Ethel Rentas, BSN, RN, CCRN, CSC

EndoTool has virtually eliminated concerns and calls from staff about insulin dosing issues. The residents and endocrinologists value its ability to manage patients effectively with minimal supervision.

EndoTool’s impact at Holy Cross extends beyond immediate patient care. Its adaptability and continuous evolution, driven by clinician feedback, ensures it remains at the forefront of glycemic management.

“EndoTool didn't just change our protocols; it continuously evolves with us. Its adaptability and support have been instrumental in maintaining high standards of care.”

Tracey Melhuish, RN, MSN, CCRN

Clinical Practice Specialist Critical Care

EndoTool’s success at Holy Cross Hospital demonstrates how patient-specific insulin dosing technology has transformed clinical practices and improved patient outcomes. The dedicated team at Holy Cross showcases how technology can be a powerful ally in enhancing patient care and safety.