The objective of the present study was to evaluate the adherence, safety, and effectiveness of a paper versus an electronic insulin infusion protocol.
This quasi-experimental implementation study compared experimental and control groups using a nonrandomized prospective cohort design.
The study was performed at 2 surgical units within a federal tertiary care teaching hospital.
Fifty-eight registered nurses volunteered.
We compared time intervals using electronic time stamps from glucometers and insulin infusion devices to measure protocol adherence. We assessed perceived adherence using a nurse survey, and, to evaluate safety, we reviewed each paper protocol infusion calculation for correctness.
Median times from blood glucose acquisition to infusion rate adjustment did not differ significantly between groups (P = .215). The majority of infusions (96.6%) had glucose acquisition times within the acceptable range. Median values of time to next "glucose due" did not differ significantly (P = .88), and relative variation in median glucose reporting times did not differ significantly between groups (P = .16). Evaluation of 877 paper protocol entries demonstrated a 10.7% (n = 94) calculation error rate. Registered nurses within the electronic group reported greater ease in balancing workload when compared with paper protocol use (P = .03). Attitudes did not differ significantly between groups in areas of determining infusion adjustment, bolus insulin dose, next glucose due, ease of access, understanding protocol, or overall satisfaction.
This study demonstrates that one can adhere to an insulin infusion protocol, regardless of the format (paper or electronic), in the medical-surgical setting. Our results suggest there are safety and nurse workload benefits when an electronic protocol was used.
Adherence, safety, and effectiveness can be achieved when using insulin infusion in the medical-surgical setting.
Author Affiliations: Medical-Surgical Clinical Nurse Specialist, Portland Veterans Affairs (VA) Medical Center, Oregon, and Adjunct Faculty at Oregon Health & Science University, Portland (Dr Locke); Registered Nurse and Certified Diabetes Educator (Ms McEuen); Computer Specialist, Portland VA Medical Center, Portland (Dr Felder); Hospitalist and Informatician, Portland VA Medical Center, Oregon, and Assistant Professor of Medicine and Medical Informatics, Oregon Health & Science University, Portland (Dr Lesselroth); Hospitalist, Portland VA Medical Center, Oregon, and Assistant Professor of Medicine, Oregon Health & Science University, Portland (Dr Barrett); Staff Nurse and Informaticist, Portland VA Medical Center, Portland (Mr Stevens); Nurse Scientist and Epidemiologist, Portland VA Medical Center, Oregon (Dr Pope).
This study was funded through the Quality Enhancement Research Initiative (QUERI), Office of Research and Development, Veterans Health Administration ($27 000).
The authors report no conflicts of interest.
Correspondence: Christy Locke, DNP, CNS, CNOR, 22117 NE 267th Ct, Battle Ground, WA 98604 (Christine.firstname.lastname@example.org).