Bilgisayar Destekli Glisemi Takip Protokolünün Yoğun Bakım Hemşirelerinin İş Yüküne Etkisi

Year 2021, Volume: 8 Issue: 3, 293 - 298, 31.12.2021

Özlem Canbolat Sevgisun Kapucu

https://doi.org/10.31125/hunhemsire.1050387

Cited By: 1

Abstract

Amaç: Bu çalışmanın amacı bilgisayar destekli glisemi takip protokolü kullanımının yoğun bakım hemşirelerinin iş yüküne etkisini belirlemektir.
Gereç ve Yöntem: Bu yarı deneysel çalışma yoğun bakım ünitesinde çalışan hemşireler ile yapılmıştır (n=19). Hemşirelerin glisemi takibi sırasında harcadıkları süre 2 gözlemci hemşire tarafından kronometre kullanılarak kaydedilmiştir. Glisemi takibi bilgisayarlı ve yazılı protokol kullanılarak yapılmıştır. Araştırmanın uygulama kısmından sonra hemşirelere protokoller hakkındaki görüşleri anket formu ile değerlendirilmiştir.
Bulgular: Bilgisayarlı protokol kullanarak yapılan glisemi takibi sırasında harcanan süre ortalama 30.5± 8.18 saniye iken, yazılı protokol kullanılarak glisemi takibi sırasında harcanan süre ortalama 42.7±10.04 saniye bulunmuştur (p<0.001). Hemşirelerin %78.9'u yazılı protokolün daha karmaşık olduğunu, %78.9'u bilgisayarlı protokolün yoğun bakım için uygun protokol olduğunu ve %78.9'u bilgisayarlı protokolü kullanmaktan memnun olduğunu belirtmiştir.
Sonuç: Bilgisayar destekli glikoz yönetim protokolü kullanımının, yoğun bakım hemşirelerinin iş yükünü azaltmada etkili olduğu gösterilmiştir. Bilgisayarlı protokol, intravenöz insülin yönetimine ihtiyaç duyan hiperglisemi hastalarının bakımında hemşire memnuniyetini artırmıştır.

Keywords

Bilgisayar destekli protokol, glisemik kontrol, hemşire iş yükü, yoğun bakım

The Effect of Computer-Assisted Glycemic Monitoring Protocol on Workload of Intensive Care Nurses

Abstract

Aim: This study aimed to determine the effect of using a computer-assisted glycemic monitoring protocol on the workload of intensive care nurses.
Material and Methods: This quasi-experimental study was conducted with intensive care unit nurses (n=19). The time spent by the nurses during glycemia follow-up was recorded by two observer nurses using stopwatches. Glycemic monitoring was performed using a computerized and written protocol. After the application part of the research, the opinions of the nurses about the protocols were evaluated with a questionnaire form.
Results: While the mean time spent on glycemia follow-up using the computerized protocol was 30.5 ± 8.18 seconds, the mean time spent using the written protocol was 42.7 ± 10.04 seconds (p < 0.001). 78.9% of nurses stated that written protocol was more complicated, 78.9% computerized protocol more suitable for intensive care unit, and 78.9% satisfied with using the computerized protocol.
Conclusion: The use of the computerized protocol was shown to be effective in reducing the workload of intensive care nurses. The computerized protocol has increased nurse satisfaction in caring for patients with hyperglycemia who need intravenous insulin management.

Keywords

Computer-assisted protocol, glycemic control, intensive care, nursing workload.

References

• 1. Clain J, Ramar K, Surani SR. Glucose control in critical care. World J. Diabetes. 2015;6(9):1082-90.
• 2. Umpierrez GE, Isaac SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87(3):978-82.
• 3. Hsu CW. Glycemic control in critically ill patients. World J. Diabetes. 2012;1(1):31-9.
• 4. Krinsley JS. Association between hyperglycemia and ıncreased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78(12):1471-8.
• 5. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: systematic overview. Lancet. 2000;355(9206):773-8.
• 6. Falciglia M, Freyberg R, Almenoff PL, D’Alessio DA, Rende ML. Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009;37(12):3001-9.
• 7. Kosiborod M, Inzucchi SE, Spertus JA, Wang Y, Masoudi FA, Havranek EP, et al. Elevated admission glucose and mortality in elderly patients hospitalized with heart failure. Circulation. 2009;119(14):1899-907.
• 8. Kosiborod M, Rathore SS, Inzucchi SE, Masoudi FA, Wang Y, Havranek EP, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction implications for patients with and without recognized diabetes. Circulation. 2005;111(23):3078-86.
• 9. Van den Berg G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in criticaly ill patients. N Engl J Med. 2001;345(19):1359-67.
• 10. Van den Berghe G, Wilmer A, Milants I, Wouters PJ, Bouckaert B, Bruyninckx F, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006;55(11):3151-9. 11. Finney SJ, Zekveld C, Elia A, Evans TW. Glucose control and mortality in critically ill patients. JAMA. 2003;290(15):2041-7.
• 12. Pittas AG, Siegel R, Lau J. Insulin therapy for critically ill hospitalized patients: a meta-analysis of randomized controlled trials. Arch Intern Med. 2004;164(18):2005-11.
• 13. Krinsley JS. Effect of an intensive glucose management protocol on the mortality of critically ill adult patients. Mayo Clin Proc. 2004;79(8):992-1000.
• 14. Taylor BE, Schallom ME, Sona CS, Buchman TG, Boyle WA, Mazuski JE, et al. Efficacy and safety of an insulin infusion protocol in a surgical ICU. J Am Coll Surg. 2006;202(1):1-9.
• 15. Wilson M, Weinreb J, Soo Hoo GW. Intensive insulin therapy in critical care a review of 12 protocols. Diabetes Care. 2007;30(4):1005-11.
• 16. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-97.
• 17. Preiser JC, Devos P, Ruiz-Santana S, Melot C, Annane D, Groeneveld J, et al. A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med. 2009; 35(10):1738-48.
• 18. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care. 2003;26(6):1902-12.
• 19. Seaquist ER, Anderson J, Childs B, Cryer F, Dagogo-Jack S, Fish L, et al. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36(5):1384-95.
• 20. Tarnow-Mordi WO, Hau C, Warden A, Shearer AJ. Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit. Lancet. 2000;356(9225):185-9
• 21. Newton CA, Smiley D, Bode BW, Kitabchi AE, Davidson PC, Jacops S, et al. A comparison study of continuous insulin infusion protocols in the medical intensive care unıt: computer- guided vs. column-based algorithms. J Hosp Med. 2010;5(8):432-7.
• 22. Olinhouse C. Development of a computerized intravenous insulin application (Autocal) at Kaiser Permanente Northwest, integrated into Kaiser Permanente Healthconnect: impact on safety and nursing workload. Perm J. 2012;16(3):67-70.
• 23. Davidson PC, Steed R, Bode BW, Hebblewhite HR, Prevosti L, Cheekati V. Use of a computerized intravenous insulin algorithm within a nurse-directed protocol for patients undergoing cardiovascular surgery. J Diabetes Sci Technol. 2008;2(3):369-75.
• 24. Correa TD, Pereira de Almeida F, Cavalcanti AB, Pereira AJ, Silva E. Assessment of nursing perceptions of three insulin protocols for blood glucose control in critically ill patients. Einstein. 2012;10(3):347-53.
• 25. Canbolat O, Kapucu S, Kılıçkaya O. Comparison of routine and computer guided glucose management for glycemic control in critically ill patients. Crit. Care Nurse. 2019;39(4):20-7.
• 26. Sucu G, Dicle A, Saka O. Decision making in clinical nursing: decision-making models and affecting factors. HEAD. 2012;9(1):52-60.
• 27. Anderson JA, Wilson P. Clinical decision support systems in nursing. computers, informatics. Nursing. 2008;26(3):151-8.
• 28. Kollef MH, Micek ST. Using protocols to ımprove patient outcomes in the intensive care unit: focus on mechanical ventilation and sepsis. Semin Respir Crit Care Med. 2010;31(1):19-30.
• 29. Boord JB, Sharifi M, Greevy RA, Griffin M, Lee VK, Webb TA, et al. Computer-based insulin infusion protocol improves glycemia control over manual protocol. J Am Med Inform Assoc. 2007;4(3):278-87.
• 30. Cavalcanti AB, Silva E, Pereira AJ, Pereira AJ, Caldeira-Filho M, Almeida FP, et al. A randomized controlled trial comparing a computer-assisted insulin infusion protocol with a strict and a conventional protocol for glucose control in critically ill patients. J Crit Care. 2009;24(3):371-8.
• 31. Lin’s concordance correlation coefficient. [Internet]. 2018 [Erişim Tarihi 05 Temmuz 2018]. Erişim adresi: https://ncss-wpengine.netdna-ssl.com/wp-content/themes/ncss/pdf/Procedures/PASS/Lins_Concordance_Correlation_Coefficient.pdf
• 32. Goldberg PA, Siegel M, Sherwin RS, Halickman JI, Lee M, Bailey VA, et al. Implementation of a safe and intensive care unit. Diabetes Care. 2004;27(2):461-7.