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    Improving Stress-Induced Hyperglycemia Management in the Intensive Care Setting

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    Author
    Elgrably, Alonya
    Issue Date
    2018
    Advisor
    Badger, Terry
    
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    Publisher
    The University of Arizona.
    Rights
    Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
    Abstract
    Background: Uncontrolled stress-induced hyperglycemia has been shown to increase mortality, prolong ICU length of stay, increase complications, and prolong ICU length of stay. The inadequate management of stress-induced hyperglycemia in the intensive care setting is a persistent gap in quality care. Objective: To implement an evidence-based Stress-induced hyperglycemia protocol in the ICU at NorthBay Medical Center. Design: Descriptive design with pre-and post-intervention measurement. Setting: The Intensive Care Unit at NorthBay Medical Center. Patients: 22 patients with stress-induced hyperglycemia. Eligible patients had a blood glucose level great than or equal to 150 mg/dL. Intervention: Patients with a blood glucose level greater than or equal to 150 mg/dL were started on sliding scale insulin therapy. Patients with a blood glucose level greater than 180 mg/dl the patient were started on an insulin infusion. If the blood glucose levels were <100 mg/dl, insulin therapy was discontinued to prevent hypoglycemia. Blood glucose levels were integrated into ICU multidisciplinary rounds to ensure all patients with stress-induced hyperglycemia were identified. Measurements: ICU length of stay, hospital length of stay, average high blood glucose levels, and number of patients who met criteria but were not started on insulin therapy were measured. Results: The average ICU length of stay pre-protocol implementation (M=4.18, SD=2.48) was greater than the average ICU length of stay post-protocol implementation (M=2.18, SD=1.83). This difference is statistically significant t (20) =2.15, p=0.044; d 0.95. There was no significant 8 difference between pre-protocol implementation hospital length of stay (M=9.27, SD=9.50) and post-protocol implementation hospital length of stay (M=6.27, SD=3.82); t (20) =0.97, p=0.343. There was no significant difference in average blood glucose levels pre-implementation (M=197, SD=69) and post-protocol implementation (M=189, SD=40); t (20) =0.31, p=0.76. Over half (55%) of the patients in the pre-implementation group met criteria for stress-induced hyperglycemia, however, insulin therapy was not initiated by the ICU healthcare provider. Postimplementation, there was 100% compliance with initiating therapy on those patients that met criteria.
    Type
    text
    Electronic Dissertation
    Degree Name
    D.N.P.
    Degree Level
    doctoral
    Degree Program
    Graduate College
    Nursing
    Degree Grantor
    University of Arizona
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