Objective

This retrospective quality improvement study examines the glycemic outcomes of pediatric and adult patients treated in surgical, medical and cardiovascular intensive care units as well as the emergency department over a three-year period following the transition from a paper-based insulin infusion protocol to a computer-based insulin infusion protocol (EndoTool).

Setting

202-bed full-service regional hospital.

Results

• Incidence of hypoglycemia <50 mg/dL decreased 85% with EndoTool, from 0.13% to 0.02% of blood glucose readings, and incidence <70 mg/dL decreased 82.5%, from 0.4% to 0.07% of blood glucose readings.
• Incidence of hyperglycemia >=180 mg/dL decreased 15% with EndoTool, from 20.3% to 17.2% of patient days.
• Other observations regarding the transition to EndoTool included: (1) glycemic control is achieved in a timely and safe manner for patients with DKA; (2) the system has been well received and is the method nurses trust and highly recommend; (3) more patients achieve set glucose targets; and (4) providers are more comfortable and willing to prescribe intravenous insulin to control hyperglycemia.

Conclusions

Use of a computer-based insulin infusion protocol (EndoTool) achieves better glycemic outcomes than a paper-based insulin infusion protocol for pediatric and adults patients alike, is effective for treating hyperglycemia and DKA, and is well received and trusted by nurses and providers.