Adult Glycemic Protocol for Intensive Care Units

Tuesday, 8 July 2008: 8:30 AM
Nikky Chahon, RN, BSN, PHN, MSN , Nursing, University of California Davis, Medical Center, Sacramento, CA
Betty M. Clark, RN, BSN, MPA , Nursing, University of California Davis Medical Center, Sacramento, CA

Learning Objective 1: recall (verbalize) two indications for maintaining aggressive glucose control in adult ICU patients.

Learning Objective 2: recall (verbalize) the correct insulin resistant factor used to initiate the insulin protocol.


The goal of this protocol was to improve therapeutic glucose levels in adult ICU patients receiving continuous intravenous insulin infusions by standardizing calculations and using an insulin resistance factor guided by evidence-based literature.

Setting, Design and Method

At UCDMC, nursing staff is responsible for regulating and maintaining insulin infusion rates after receiving a physicians' order for a continuous insulin infusion. Previously, adjustment and titration to the intravenous drip rates was done based on hourly blood glucose levels.

To improve patient safety and outcomes while on continuous intravenous insulin infusions, a standardized protocol for adult ICU's was developed. This included a nursing worksheet for calculating insulin rates using a baseline insulin resistant factor (IRF) of 0.02. Within six months, pharmacy developed a calculator for the electronic medical record that preset insulin resistance factors and calculated rates based on blood glucose levels. This standardized infusion rates for all patients based on IRF and blood glucose.

Medical ICU patients requiring continuous insulin therapy were placed on the new adult glycemic protocol. This protocol introduced the standardized formula for calculating insulin infusion rates using an insulin resistance factor of 0.02. Nurses completed paper worksheets calculating drip rates and these worksheets were collected over one year's time. Data from the worksheets was then analyzed and graphs created to visualize the effects of the new insulin protocol.

Concept Targeted

The protocol was developed to provide an evidenced-based method for standardized insulin infusion rates that nurses could use when adult ICU patients were on continuous insulin infusions.


Initial findings indicate that tighter glucose control improved patients' blood glucose levels in a more consistent and timely manner.


Initiating the adult insulin protocol has decreased errors in calculating infusion rates and standardized the means for calculating the hourly infusion rates.