Stamping out hypoglycemia in a surgical Intensive Care Unit: A multidisciplinary approach

Context: Both hyperglycemia and hypoglycemia can significantly impact outcomes in critically ill patients. In the Intensive Care Unit (ICU), hypoglycemia is often the result of intensive insulin therapy. Aims: The purpose of this study is to assess the impact of insulin infusion associated hypoglycemia using a multidisciplinary quality improvement approach with targeted education and real-time follow-up in a surgical ICU. Setting and Design: A concurrent study in a surgical ICU of an academic medical center. Materials and Methods: Our clinical pharmacists concurrently reviewed all cases of hypoglycemia (glucose Statistical Analysis: Fisher's exact test for nominal data. Results: Four hundred and twenty-nine hypoglycemic events (188 patients) occurred in 2233 patient admissions. Most events involved administration of insulin (40%), including 106 (25%) involving insulin infusions and 59 (14%) associated with sliding scale insulin administration. Education significantly reduced the percentage of hypoglycemic events due to noncompliance (47% pre vs. 17% post, P = 0.002). Conclusions: Education and unit feedback with concurrent staff follow-up were associated with a significant reduction in the rate of hypoglycemic events. The following core competencies are addressed in this article : Patient care, practice-based learning and improvement.