ORLANDO — The use of a computer protocol to achieve tight glycemic control dramatically lowered insulin administration errors, compared with a paper-based protocol, according to a study of simulated patients in an intensive care unit.
The computer format also improved satisfaction among ICU nurses, Dr. Anthony Y. Lee of Columbus Children's Hospital in Ohio said at the annual congress of the Society of Critical Care Medicine.
Dr. Lee and colleagues at the University of Maryland Medical Center, Baltimore, recruited 51 medical ICU nurses to complete seven simulated patient scenarios using both the standard paper-based insulin protocol and a computer version of the protocol. The scenarios included a clinical case description, a current insulin dose, and new and previous blood glucose level. The nurses were given standardized instructions on how to use both paper and computer versions of the protocol and were required to indicate the new insulin dose and the time of the next blood glucose check.
The simulated situations produced 357 paper responses and 357 computer responses showing a significant reduction in errors using the computer format. Use of the paper protocol resulted in 82 insulin-dosing errors, compared with 4 errors using the computer system. It seemed that the same study participant committed all four errors using the computer protocol.
Errors in the timing of the next blood glucose check fell from 47 with the paper-based protocol to 8 with the computer format. The time to completion fell from 9 minutes with the paper-based protocol to 6 minutes with the computer program.