In-patients insulin therapy protocol: establishment and valuation
Clara Garcia, Cristobal Morales, Juan Garcia-Quiros, Monica Tome, Ignacio Fernandez, Isabel Serrano & Angel Sendon
Introduction: An insulin therapy protocol (ITP) was created during 2007 in our hospital by endocrinologists, internal physicians and nurses. The aim was to establish the basal-bolus therapy as the treatment for the non-critical diabetic in-patients in order to ease the management and lead a better glycemic control of these patients. A poster was presented to all the hospital departments in several meetings during 2008. This poster showed the way to calculate the initial insulin doses, how adjust them, how to use intravenous insulin and the best treatment at the time of discharge.
Objectives: The purpose of this project is to valuate the use and comprehension of this ITP.
Method: A cross-sectional study was made in a random day checking the treatment of the diabetic in-patients. In addition, a test was made for nurses and physicians asking about knowledge, use and valuation of the ITP. They were also asked about the reason to avoid the use of the ITP and glycemic values considered optimal in critical and non-critical patients.
Results: 1. ITP valuation test: 23 nurses and 38 physicians were tested. All the doctors and 95% of the nurses knew ITP. 50.8% admitted the use of the protocol in 80% or more of the patients. The main reason to avoid using the protocol was to consider it not applicable to some patients. 57% thought the protocol was clear. Glycemic values considered optimal for critical patients were between 90 and 150 mg/dl (4.7 and 8 nmol) and between 80 and 140 mg/dl (4.25 and 7.5 nmol) for non critical patients. Most of the staff thought the ITP was needed to improve the diabetic patient treatment. They also suggested it was easy to use. Hyper and hypoglycemia occurred less frequently whith this protocol.
2. Protocol application: the day the study was made 25% of the in-patients were diabetics. ITP was used in the 79% of the diabetic in-patiets (96% in medical departments, 45% in surgery departments, 77% in Alerts and Emergencies department and 0% in Intensive Care Unit). Other treatments used were regular insulin therapy every 6 h and oral drugs.
Conclusions: ITP was the main treatment used in the diabetic in-patients.
The ITP has been well valuated by most of the staff although it has been better established in the medical areas so further efforts are needed to extend its use to the rest of departments.