Objective

This prospective randomized controlled trial compares glycemic control and nursing satisfaction with a computerized insulin dosing system (EndoTool) to a paper protocol in a cardiovascular surgical intensive care unit.

Setting

400-bed rural community regional referral hospital.

Results

• Percentage of blood glucose measurements in the target range of 80-150 mg/dL was 14.3% higher with EndoTool (70.4% ± 15.2 vs 61.6% ± 17.9).
• Glucose variability was 16.3% lower with EndoTool (35.5 mg/dL ± 18.3 vs 42.3 mg/dL ± 21.2)
• lncidence of hypoglycemia <60 mg/dL was 58.4% lower with EndoTool (4.96% vs 11.92% of patients).
• Mean score for nursing satisfaction was 75% higher with EndoTool (8.4 ± 1.4 vs 4.8 ± 2.4 on a scale of 1 to 10).
• Deviation from protocol was 87% lower with EndoTool (0.39 ± 1.0 vs 3.0 ± 4.3 times per patient).

Conclusions

The process of glycemic control improves with use of a computerized system (EndoTool) over a paper protocol, as evidenced by a greater percentage of blood glucose measurements in the target range, lower glucose variability, fewer hypoglycemia events and higher nursing satisfaction/compliance, leading to a determination that use of EndoTool is best practice for intravenous insulin dosing.