Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap
Background. Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycae...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
South African Medical Association
2017-07-01
|
| Series: | Southern African Journal of Critical Care |
| Online Access: | http://www.sajcc.org.za/index.php/SAJCC/article/view/280/269 |
| _version_ | 1797332543297552384 |
|---|---|
| author | D Maharaj H Perrie J Scribante F Paruk |
| author_facet | D Maharaj H Perrie J Scribante F Paruk |
| author_sort | D Maharaj |
| collection | DOAJ |
| description | Background. Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycaemia, evidence-based protocols are implemented to guide clinical care. However, it has been suggested that with the use of protocoldirected therapy, protocol-practice gaps are common and therefore protocol adherence must be audited regularly. The aim of this study was to evaluate adherence to the glucose control protocol by nurses in the cardiothoracic intensive care unit (ICU) at a tertiary academic hospital.
Methods. A retrospective study involving the review of ICU charts of all post-cardiac surgery patients ≥16 years admitted to the cardiothoracic ICU during March 2011. A convenience sampling method was used.
Results. A total of 741 glucose readings for 22 patients were evaluated. The median (interquartile range) glucose reading was 7.8 mmol/L (6.7 - 9.3 mmol/L). Overall, 411 (55.5%) protocol violations were recorded and 629 (84.9%) of the total readings were abnormal. Protocol violations were similar between the day and night staff; 188 (54.7%) and 223 (58.5%) were recorded, respectively (p=0.256). Of the readings, 464 (62.6%) were conducted by ICU-trained nurses and 245 (33.2%) by non-ICU-trained nurses. There were fewer protocol violations recorded by the ICU-trained nurses compared with the non-ICU-trained nurses, i.e. 53.3% and 63.7%, respectively (p<0.05).
Conclusion. Adherence to the glucose-control protocol was suboptimal. These results may suggest that the training and education of healthcare workers in implementing protocols is an ongoing and dynamic process, and that there is a need for the regular evaluation of protocol adherence in order to identify protocol-practice gaps. |
| first_indexed | 2024-03-08T07:51:24Z |
| format | Article |
| id | doaj.art-fefe1ef909e740a9a5b73e7a27bc93d6 |
| institution | Directory Open Access Journal |
| issn | 1562-8264 2078-676X |
| language | English |
| last_indexed | 2024-03-08T07:51:24Z |
| publishDate | 2017-07-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | Southern African Journal of Critical Care |
| spelling | doaj.art-fefe1ef909e740a9a5b73e7a27bc93d62024-02-02T14:48:29ZengSouth African Medical AssociationSouthern African Journal of Critical Care1562-82642078-676X2017-07-013314710.7196/SAJCC.2017.v33i1.280Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gapD Maharaj0H Perrie1J Scribante2F Paruk3Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaDepartment of Critical Care, Faculty of Health Sciences, University of Pretoria, South AfricaBackground. Glycaemic control constitutes an important component in the management of critically ill patients. As such, all healthcare workers involved in the management of critically ill patients need to ensure that it is achieved adequately. To avoid glucose variability and to maintain normoglycaemia, evidence-based protocols are implemented to guide clinical care. However, it has been suggested that with the use of protocoldirected therapy, protocol-practice gaps are common and therefore protocol adherence must be audited regularly. The aim of this study was to evaluate adherence to the glucose control protocol by nurses in the cardiothoracic intensive care unit (ICU) at a tertiary academic hospital. Methods. A retrospective study involving the review of ICU charts of all post-cardiac surgery patients ≥16 years admitted to the cardiothoracic ICU during March 2011. A convenience sampling method was used. Results. A total of 741 glucose readings for 22 patients were evaluated. The median (interquartile range) glucose reading was 7.8 mmol/L (6.7 - 9.3 mmol/L). Overall, 411 (55.5%) protocol violations were recorded and 629 (84.9%) of the total readings were abnormal. Protocol violations were similar between the day and night staff; 188 (54.7%) and 223 (58.5%) were recorded, respectively (p=0.256). Of the readings, 464 (62.6%) were conducted by ICU-trained nurses and 245 (33.2%) by non-ICU-trained nurses. There were fewer protocol violations recorded by the ICU-trained nurses compared with the non-ICU-trained nurses, i.e. 53.3% and 63.7%, respectively (p<0.05). Conclusion. Adherence to the glucose-control protocol was suboptimal. These results may suggest that the training and education of healthcare workers in implementing protocols is an ongoing and dynamic process, and that there is a need for the regular evaluation of protocol adherence in order to identify protocol-practice gaps.http://www.sajcc.org.za/index.php/SAJCC/article/view/280/269 |
| spellingShingle | D Maharaj H Perrie J Scribante F Paruk Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap Southern African Journal of Critical Care |
| title | Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap |
| title_full | Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap |
| title_fullStr | Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap |
| title_full_unstemmed | Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap |
| title_short | Glycaemic control in a cardiothoracic surgical population: Exploring the protocol-practice gap |
| title_sort | glycaemic control in a cardiothoracic surgical population exploring the protocol practice gap |
| url | http://www.sajcc.org.za/index.php/SAJCC/article/view/280/269 |
| work_keys_str_mv | AT dmaharaj glycaemiccontrolinacardiothoracicsurgicalpopulationexploringtheprotocolpracticegap AT hperrie glycaemiccontrolinacardiothoracicsurgicalpopulationexploringtheprotocolpracticegap AT jscribante glycaemiccontrolinacardiothoracicsurgicalpopulationexploringtheprotocolpracticegap AT fparuk glycaemiccontrolinacardiothoracicsurgicalpopulationexploringtheprotocolpracticegap |