Construction And Effect Evaluation Of Blood Glucose Management Program For ICU Patients Led By Intensive Care Specialist Nurses

PurposeThe purpose of this study is to establish a blood glucose management scheme for ICU patients led by intensive care nurses based on goal-oriented theory,and to explore the feasibility of this scheme and verify the clinical effect,and provide reference for clinical nurses to manage blood glucose in ICU patients.MethodThis study was divided into two parts.1.The first part is the formulation of intervention program.A blood glucose management program formulation team of a multidisciplinary team was formed.Based on the goal-oriented theory and literature review,semi-structured interviews,and discussion of the program formulation group,a blood glucose management program for ICU patients led by intensive care specialist nurses was initially constructed,and the blood glucose management program was revised by Delphi expert letter consultation method.Finally,the "ICU Patient blood glucose Management Program led by Intensive care specialist nurses" was formulated.2.The second part is the effect evaluation of intervention program.A total of 268 patients with hyperglycemia who received intravenous insulin infusion treatment in the intensive care unit of a Grade III Class A general hospital in Qingdao from July 2021 to August 2022 were selected as the study objects.A total of 134 patients with hyperglycemia who received intravenous insulin infusion in ICU from July 2021 to December 2021 were retrospectively selected as the control group,and 134 patients with hyperglycemia who received intravenous insulin infusion in ICU from March 2022 to August 2022 were selected as the experimental group.The total number of blood glucose measurements,blood glucose level and time to reach the standard of blood glucose,and insulin dosage at the first time of reaching the standard of blood glucose were compared between the two groups.The number of blood glucose measurements and blood glucose level on the 1st to 5th day of ICU hospitalization;The incidence of hypoglycemia;The proportion of blood glucose measured values within the target range;Duration of intravenous insulin infusion;Coefficient of blood glucose variation on day 1-5 of ICU admission.Results1.A blood glucose management scheme was constructed,which included 7 primary indexes,14 secondary indexes and 53 tertiary indexes.After two rounds of expert letter consultation,the questionnaire recovery rates were 94.2% and 93.9%,respectively.The expert authority coefficients(Cr)of the two rounds of correspondence consultation were0.899 and 0.925,respectively.Kendall’s W was 0.342 and 0.347,respectively,P <0.05.After two rounds of expert consultation,the blood glucose management plan for ICU patients led by intensive care specialist nurses(final draft)was formulated according to the results of the consultation combined with clinical practice.2.The results of controlled clinical trials show that:(1)There was no significant difference in age,BMI,medical history,complications and other general information between the two groups(P>0.05),indicating homogeneity.There were no statistical differences between the two groups in mechanical ventilation,blood purification therapy,APACHE Ⅱ score,the use of glucocorticoid drugs and vasoactive drugs(P>0.05),which was comparable.(2)There was no significant difference in the total number of blood glucose measurements between the two groups(P>0.05).The average value and maximum value of blood glucose in the experimental group were lower than that in the control group,while the minimum value in the experimental group was significantly higher than that in the control group,with statistical significance(P<0.05).The dosage of insulin in the experimental group was significantly lower than that in the control group when the blood glucose reached the standard for the first time,and the difference was statistically significant(P<0.05).The time of blood glucose reaching target in the experimental group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).(3)There were no significant differences between the two groups in the number of blood glucose measurements on days 1-5,the mean value,maximum value and minimum value of blood glucose on day 1,with no statistical significance(P>0.05);Blood glucose levels on days 2-5 of the two groups: the mean and maximum values of the experimental group were lower than those of the control group,and the difference was statistically significant(P<0.05);The minimum value of the experimental group was higher than that of the control group,and the difference was statistically significant(P<0.05).(4)The incidence of hypoglycemia in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).The frequency of hypoglycemia in each patient was lower than that in the control group,and the difference was statistically significant(P<0.05).(5)There was no statistical significance in the duration of intravenous insulin infusion between 2 groups(P>0.05).The application of insulin in the experimental group at the highest value of blood glucose was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).(6)The proportion of blood glucose measured in the target range(8-12mmol/L)in the experimental group was higher than that in the control group,and the difference was statistically significant(P<0.05).(7)On day 1,there was no significant difference in blood glucose variability between the experimental group and the control group(P>0.05).The difference of blood glucose variability between the experimental group and the control group was statistically significant from day 2-5(P<0.05).ConclusionThe "ICU blood glucose management program led by intensive care nurses" is highly reliable,scientific and feasible.The program can effectively reduce the time of blood glucose reaching the target,reduce the incidence of hypoglycemia,reduce the variation of blood glucose,and reduce the insulin dosage when blood glucose reaches the target for the first time.There is no obvious advantage in the total number of blood glucose measurements.