Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit
Vogelzang M, Zijlstra F, Nijsten MW. Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit. BMC Med Inform Decis Mak. 2005 Dec 19; 5: 38
Tight glucose control is essential in patients suffering from "stress hyperglycemia" in an intensive care setting. Aggressive insulin treatment has been shown to decrease morbidity and mortality. Given this therapy can result in life-threatening hypoglycemia, insulin-based nurse and paper protocols exist.
Some physicians and nurses argue for achieving the tightest control through high frequency testing. However, paper-based systems result in multiple decision points with poorly managed hyperglycemia and hypoglycemia still occurring. Researchers in the Netherlands have developed a computer decision support system (glucose regulation for intensive care patients (GRIP)), primarily used by nurses, to aid in recommending the insulin rate and time for the next blood draw.
The system also contained alerts for hyper/hypoglycemic values with requests to contact the physician. During a 4-month period, using GRIP, 179 hyperglycemic patients were treated and severe hypoglycemia (<2.2 mmol/L), due to human error, only occurred once in one patient (0.6%) and mild hypoglycemia (<3.5 mmol/L) occurred in 20 patients (11.2%). Furthermore, glucose levels met the target range for more than three-quarters of the time in 66 patients (61%) and glucose sampling was less than 6 times a day for 76 patients (70%). After initiation of GRIP nurses judged glucose control to be running more smoothly than before (p< 0.001).
This study showed that an easy to train computer decision support system improves intensive care patient glucose management without inducing hypoglycemia while generating efficiency and creating user satisfaction.