Implementation of an Evidence-Based Protocol for Blood Glucose Management in Critically Ill Adult Patients: A Pilot Study.

BACKGROUND

Critically ill patients are prone to stress hyperglycaemia, which can negatively impact clinical outcomes at high blood glucose levels. Evidence-based blood glucose management practices to improve patient outcomes should be explored.

AIM

This pilot study aimed to implement an evidence-based glycaemic management protocol for critically ill adults and assess its impact on ICU nurses' knowledge, attitudes, behaviours as well as healthcare professionals' adherence and patient outcomes.

STUDY DESIGN

This quasi-experimental study included a controlled pre-post pilot study that was conducted from April to June 2023 in a general ICU. An evidence-based glycaemic management protocol was developed for critically ill adults using the Rosswurm and Larrabee model for evidence-based practice change. The study cohort ultimately comprised 48 ICU nurses who completed both pre- and post-implementation surveys and 61 patients (control group, 34; intervention group, 27). ICU nurses' knowledge, attitudes and behaviours; healthcare providers' compliance; and patients' clinical outcomes were measured to assess the effectiveness of the intervention.

RESULTS

After implementing the intervention, ICU nurses' knowledge, attitudes and behaviours toward glycaemic management significantly improved. Among the 38 indicators of healthcare providers' compliance, 12 showed a 0%-100% improvement rate post-implementation and 8 showed a compliance rate increase of 5.9%-66.7%. Statistically significant improvements were found in the duration of hyperglycaemia (t = 2.841, p < 0.05, 95% CI [4.15, 24.46]), time to reach target glucose levels (t = -2.215, p < 0.05, 95% CI [-12.02, -0.61]) and rate of complications (χ = 4.325, p < 0.05) among patients.

CONCLUSIONS

The evidence-based glycaemic management protocol for critically ill adults is feasible and effective for clinical use. The Rosswurm and Larrabee model was useful for guiding the implementation of the protocol in mainland China.

RELEVANCE TO CLINICAL PRACTICE

This pilot study provides a reference for blood glucose management in critically ill patients. Through structured training and procedural refinements, it facilitated the optimization of clinical workflows for glycaemic control, promoting a paradigm shift from experience-based to evidence-driven nursing practices among ICU nurses.