The hospitalwide collaboration in the protocol has been crucial to its success, he added. For example, “they're even working out the relationship between insulin dosing and distribution of meals—two completely different areas and responsibilities of the hospital, and yet they've coordinated medication and food delivery to make it safer for patients.”
Proceedings from a recent conference chaired by Dr. DeVita on rapid-response teams are available online at www.metconference.com
Nurses Key to Consistency, Monitoring
The UPMC hypoglycemia treatment protocol need not be administered by a physician but can be initiated by the bedside nurse, Dr. Korytkowski noted. For all patients covered by the protocol, the responder is required to contact a physician and to recheck glucose 15 minutes after the initial treatment.
In each of three categories of blood glucose and patient consciousness level, the protocol lists treatment options and required steps. For example, for alert patients with blood glucose less than 50 mg/dL, the initial options are to give the patient an 8-ounce glass of milk, to give two tubes of glucose gel if the patient can swallow thick liquids, or if the patient can't take anything by mouth, to give 50 mL 50% dextrose solution intravenously (1 ampule). Intravenous dextrose 5% in water can be started at 100 mL/hour for a prolonged episode.
In patients with blood glucose near the upper end of the 70-mg/dL limit who are still conscious, the treatment may be “as simple as a glass of orange juice,” Dr. Korytkowski said. For other patients, the treatment might be intravenously administered glucose.