| Summary: | A research report submitted to the Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, in
partial fulfilment of the requirements for the degree of
Master of Medicine
in the branch of Anaesthesiology
2015 === Background: Glucose control in critically ill patients poses a challenge for all
health care workers involved in patient management. To avoid glucose variability
and to maintain normoglycaemia, evidence based protocols are implemented to
guide clinical care. However, adherence to such protocols needs to be evaluated
on a regular basis in order to ensure efficiency of care and to improve outcomes.
Available literature suggests that glucose control protocol compliance is generally
poor.
Aim of the study: The aim of the study was to evaluate adherence to the
glucose control protocol by nurses in the cardiothoracic ICU at CMJAH.
Objectives of the study: The research objectives were to:
1. Describe the number of abnormal glucose readings recorded.
2. Describe the proportion of protocol violations in relation to the glucose control
protocol.
3. Compare the differences in glucose protocol violations between day nursing
staff and night nursing staff.
4. Compare the level of training of nurses involved with glucose protocol
violations.
Method: A retrospective study reviewing the ICU charts of adult patients post
cardiac surgery, who were admitted to the cardiothoracic ICU at Charlotte Maxeke
Johannesburg Academic Hospital, Gauteng, during March 2011. The data was
analysed using STATA 11 statistical software.
Results: A total of 741 glucose readings were evaluated [22 patients: 13 (59.1%)
male and 9 (40.9%) female]. The mean age of patients was 48.5 years with an age
range of 17-76 years. The surgical procedures were categorised as: valvular 17
(77.3%); coronary artery bypass grafts 3 (13.6%) and other 2 (9.1%). The median
glucose reading was 7.8 mmol/l (6.7-9.3 mmol/l). Overall, 411 (55.5%) protocol
violations were recorded if the glucose control protocol was not adhered to. Of the
readings 629 (84.9%) were abnormal. Protocol violations were similar between the
day and night staff; 188 (54.7%) and 223 (58.5%) respectively (p =0.256). Of the
readings, 464 (62.6%) were done by ICU trained nurses and 246 (33.2%) by non-
ICU trained nurses. There were fewer protocol violations recorded by the ICU
trained nurses compared to the non-ICU trained nurses, i.e. 53.3% and 63.7%
respectively (p<0.05).
Conclusion: It is concluded that adherence to the glucose control protocol in
the ICU was sub-optimal. Despite a high percentage of protocol violations, the
median glucose level was 7.8 mmol/l. The number of violations committed by the
day and night staff was similar. ICU trained nurses committed fewer violations than
non-ICU trained nurses.
These results 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 evaluation on a regular basis.
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