Nurse-Led Quality Initiative Cuts Hypoglycemia in ICU Patients

Nurse-driven root cause analysis is associated with a substantial reduction in hypoglycemia in the intensive care unit, according to a study published in the August issue of in Critical Care Nurse.

Krista E. Shea, M.S.N., from Stamford Hospital in Connecticut, and colleagues conducted real-time analysis of each episode of hypoglycemia (blood glucose level <60 mg/dL) occurring at a 16-bed critical care unit of a university-affiliated teaching hospital. The interdisciplinary team also evaluated patient risk factors and nursing interventions once root cause analysis was incorporated into daily practice.

The researchers found that the percentage of patients with hypoglycemia decreased substantially during the implementation period among both those without diabetes (6.15 to 3.78 percent) and with diabetes (13.14 to 7.23 percent). Among patients without diabetes, mean blood glucose level decreased during the implementation period; among patients with diabetes, it did not change significantly. Additionally, glucose variability (as measured by the coefficient of variation) decreased during the implementation period among patients without and with diabetes.

"By finding a process to drill down to a new level of detail regarding the variety of factors that can lead to hypoglycemia, nurses were able to examine their own practice and make relatively minor adjustments that produced positive results," the authors write.

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