A retrospective comparative audit, investigating the glycaemic control implemented in two Intensive Care Units

Tomlinson, Victoria (2011) A retrospective comparative audit, investigating the glycaemic control implemented in two Intensive Care Units. [Dissertation (University of Nottingham only)] (Unpublished)

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Background: Critically ill patients can experience stress-induced hyperglycaemia. Glycaemic control therapy is administered to control patients’ blood glycaemic levels and reduce the incidence of infection, myocardial infarctions and organ failure. However, there are many factors influencing the effectiveness of glycaemic control and contradicting literature. Therefore, there is a need for an audit of current practice.

Methods: As an audit has never taken place on the administration of glycaemic control, a retrospective audit was carried out on patients’ case notes in two Intensive Care Units (ICU), to examine what glycaemic control therapy was implemented and its effectiveness. This method prevents the study outcomes being swayed towards any particular direction because the glycaemic control has already taken place, and to reduce selection bias the most recent available case notes were selected.

Results: Different glycaemic control protocols were being implemented in each hospital setting, despite both belonging to the same ICU network. It was found in most incidences that regardless of age, diabetes status or current diagnosis, patients were administered the same sliding scale insulin (SSI) and medications were not taken into account. It was also learnt that some medics adapted the hospital titration regimens and that Actrapid was the only insulin used for SSI.

A new glycaemic range was also discovered; 85.2% (n=109) of patients (across Hospital A and B) receiving glycaemic control were not controlled in hypoglycaemia, normoglycaemia or hyperglycaemia. They had mean average blood glycaemic levels maintained between 5.7-9.9mmol/L, now described as medioglycaemia (Tomlinson, 2011).

Conclusion: To overall improve glycaemic control and increase effectiveness and safety of practice for patients a new comprehensive guideline needs to be developed for glycaemic control. This needs to include recommendations of how to adapt the titration regimen to individuals, taking into account their age, diabetes status, diagnosis and medications.

Item Type: Dissertation (University of Nottingham only)
Depositing User: EP, Services
Date Deposited: 04 Aug 2011 13:54
Last Modified: 18 Dec 2017 16:51
URI: https://eprints.nottingham.ac.uk/id/eprint/24784

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