Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit

BMC Medical Informatics and Decision Making - Tập 5 - Trang 1-10 - 2005
Mathijs Vogelzang1,2, Felix Zijlstra2, Maarten WN Nijsten1
1Surgical Intensive Care Unit, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
2Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Tóm tắt

Tight glucose control by intensive insulin therapy has become a key part of critical care and is an important field of study in acute coronary care. A balance has to be found between frequency of measurements and the risk of hypoglycemia. Current nurse-driven protocols are paper-based and, therefore, rely on simple rules. For safety and efficiency a computer decision support system that employs complex logic may be superior to paper protocols. We designed and implemented GRIP, a stand-alone Java computer program. Our implementation of GRIP will be released as free software. Blood glucose values measured by a point-of-care analyzer were automatically retrieved from the central laboratory database. Additional clinical information was asked from the nurse and the program subsequently advised a new insulin pump rate and glucose sampling interval. Implementation of the computer program was uneventful and successful. GRIP treated 179 patients for a total of 957 patient-days. Severe hypoglycemia (< 2.2 mmol/L) only occurred once due to human error. With a median (IQR) of 4.9 (4.2 – 6.2) glucose measurements per day the median percentage of time in which glucose fell in the target range was 78%. Nurses rated the program as easy to work with and as an improvement over the preceding paper protocol. They reported no increase in time spent on glucose control. A computer driven protocol is a safe and effective means of glucose control at a surgical ICU. Future improvements in the recommendation algorithm may further improve safety and efficiency.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6947/5/38/prepub

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BMC Medical Informatics and Decision Making

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