ABSTRACT
By
Daleen Aragon, RN, PhD, CCRN.
Background Tight glycemic control is important
in critically ill patients and involves insulin infusions and monitoring of
blood glucose levels. Hourly measurements of blood glucose levels and
adjustments of intravenous insulin doses require additional work by nurses.
Objectives To evaluate the nursing work incurred
with and nursing perceptions about tight glycemic control and blood glucose
monitoring.
Methods A variety of intensive care units
were studied. Surveys were used to gain information about nurses’ perceptions.
Time-in-motion observations were used to determine the time taken to measure blood
glucose levels and adjust insulin doses.
Results Nurses thought that tight glycemic
control was important and that the work associated with it was substantial.
Nurses thought that easier and automated forms of blood glucose monitoring are
needed. They preferred using an arterial catheter to obtain blood samples to
avoid excessive finger sticks. The total number of blood glucose measurements
was 77 954. The mean time taken for hourly blood glucose monitoring and
adjustment of insulin doses was 4.72 minutes. The estimated costs of time spent
on glycemic control during a 1-year period were $182 488 for nurses’ salaries
and $58 500 for supplies.
Conclusions
Although most nurses endorse tight glycemic control, the work
associated with it is burdensome and costly. Because up to 2 hours might be
required for tight glycemic control for a single patient in a 24-hour period,
the costs in time and money are high. Easier clinical methods for monitoring blood
glucose levels are needed. (American Journal of Critical Care.
2006;15:370-377)
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