What are the key components of an IV insulin therapy protocol?

Updated: Nov 06, 2018
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: George T Griffing, MD  more...
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Key components to the institution of an intravenous insulin protocol are as follows:

  • Define present management of hyperglycemia.

  • Determine need for improved management of hyperglycemia.

  • Create a multidisciplinary committee for management, including the following:

    • Physician (medical and/or surgical; ICU and endocrinology input ideal)

    • Nurse

    • Nutritionist (dietary service)

    • Pharmacist

  • Identify necessary resources, including the following:

    • Point-of-care glucometers vs laboratory analysis

    • Pharmacy staff (intravenous insulin preparations)

    • Nursing requirements and training

    • Nutritional assessment and monitoring (continuous enteral or parenteral nutrition)

    • Management of hypoglycemia

    • Transition from intravenous to subcutaneous preparations

  • Select the intravenous insulin protocol, which includes the following:

    • Local development vs use of existing protocol (assess need for modification)

    • Nurse-driven vs element of physician oversight

    • Standardization of order sets (paper, computerized, web-based)

    • Computerized order entry programs

    • Training of physician and nursing staff

  • Metrics for evaluation include the following:

    • Percentage of patients above 180 mg/dL

    • Percentage of patients within specific target (ie, 140-180 mg/dL)

    • Hypoglycemia (percentage of patients < 45 mg/dL)

    • Sternal wound infections

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