Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel

Optimizing hospital use of intravenous insulin therapy: improved management of hyperglycemia and error reduction with a new nomogram.

Publication ,  Journal Article
Lien, LF; Spratt, SE; Woods, Z; Osborne, KK; Feinglos, MN
Published in: Endocr Pract
2005

OBJECTIVE: To assess the efficacy and safety of intravenous (IV) insulin administration with use of our institution's old protocol (pre-nomogram phase) as compared with our new insulin nomogram (post-nomogram phase), which titrates insulin dose based on the rate of change of plasma glucose values and uses multipliers to determine the new insulin infusion rate. METHODS: Hospitalized adults receiving an IV insulin infusion in our tertiary care medical center were enrolled in this study after informed consent was obtained. The study was an observational analysis conducted before and after implementation of the new insulin infusion nomogram. Measurements included episodes of hypoglycemia and incidence of the following errors in the insulin infusion process: (1) episodes of documented failure to increase insulin infusion rate despite persistent hyperglycemia and (2) number of times the IV infusion was stopped without subcutaneous administration of insulin. RESULTS: Overall, 66 patients were analyzed (38 in the pre-nomogram phase and 28 in the post-nomogram phase). The new nomogram reduced by nearly 3-fold (from 0.89 +/- 0.68 to 0.36 +/- 0.49 occurrence per patient per 24 hours; P<0.001) the mean incidence of failure to give insulin subcutaneously before discontinuation of IV insulin infusion. Moreover, the nomogram nearly eliminated the error of caregiver nonresponsiveness to persistent hyperglycemia: mean incidence 0.39 +/- 0.65 occurrence per patient per 24 hours before implementation of the new nomogram versus 0.02 +/- 0.09 afterward (P<0.002). There was no statistically significant difference in episodes of hypoglycemia between the 2 study groups. CONCLUSION: Safe IV administration of insulin through error prevention is essential. Implementation of a new IV insulin infusion nomogram, which adjusts insulin infusion using multipliers, reduces errors and improves glycemic control without increasing hypoglycemic episodes.

Duke Scholars

Published In

Endocr Pract

DOI

ISSN

1530-891X

Publication Date

2005

Volume

11

Issue

4

Start / End Page

240 / 253

Location

United States

Related Subject Headings

  • Nomograms
  • Middle Aged
  • Medical Errors
  • Male
  • Intensive Care Units
  • Insulin
  • Infusions, Intravenous
  • Hyperglycemia
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lien, L. F., Spratt, S. E., Woods, Z., Osborne, K. K., & Feinglos, M. N. (2005). Optimizing hospital use of intravenous insulin therapy: improved management of hyperglycemia and error reduction with a new nomogram. Endocr Pract, 11(4), 240–253. https://doi.org/10.4158/EP.11.4.240
Lien, Lillian F., Susan E. Spratt, Zinta Woods, Kim K. Osborne, and Mark N. Feinglos. “Optimizing hospital use of intravenous insulin therapy: improved management of hyperglycemia and error reduction with a new nomogram.Endocr Pract 11, no. 4 (2005): 240–53. https://doi.org/10.4158/EP.11.4.240.
Lien LF, Spratt SE, Woods Z, Osborne KK, Feinglos MN. Optimizing hospital use of intravenous insulin therapy: improved management of hyperglycemia and error reduction with a new nomogram. Endocr Pract. 2005;11(4):240–53.
Lien, Lillian F., et al. “Optimizing hospital use of intravenous insulin therapy: improved management of hyperglycemia and error reduction with a new nomogram.Endocr Pract, vol. 11, no. 4, 2005, pp. 240–53. Pubmed, doi:10.4158/EP.11.4.240.
Lien LF, Spratt SE, Woods Z, Osborne KK, Feinglos MN. Optimizing hospital use of intravenous insulin therapy: improved management of hyperglycemia and error reduction with a new nomogram. Endocr Pract. 2005;11(4):240–253.

Published In

Endocr Pract

DOI

ISSN

1530-891X

Publication Date

2005

Volume

11

Issue

4

Start / End Page

240 / 253

Location

United States

Related Subject Headings

  • Nomograms
  • Middle Aged
  • Medical Errors
  • Male
  • Intensive Care Units
  • Insulin
  • Infusions, Intravenous
  • Hyperglycemia
  • Humans
  • Female