Achieving tight glycaemic control.

The implementation of tight glycaemic control (TGC) is becoming accepted best practice within intensive care units throughout the world. It is recommended by the Surviving Sepsis Campaign and is included in the sepsis care bundle. The major impact of TGC is currently thought to be associated with reduced morbidity and mortality. The process of achieving TGC is, however, not without risk. In particular, the need for frequent, accurate blood glucose measurement and the possibility of prolonged, unrecognised hypoglycaemia are of concern. There is also the potential for patients who exhibit significant insulin resistance to require the administration of large amounts of insulin. The transfer of patients from the intensive care unit to the operating theatre or for computerised tomography during intensive insulin therapy is also hazardous. The purpose of this paper is to describe a series of nurse led pilot studies which aimed to introduce the process of TGC whilst maintaining patient safety. The results demonstrate the effectiveness of a staged approach and the achievement of TGC.