New Joint Commission Protocol on Insulin

Nurses General Nursing

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My hospital will be instilling this new Joint Commission Insulin gtts protocol in my ICU. I was just wondering if anyone out there has had to use their new protocol yet, being a requirement now?

I'm a little disgruntled about it. The new protocol now includes insulin boluses and a table to determine the next insulin dose for that hour on the gtts.

I thought things were working fine when we nurses titrated the insulin drip based on our discretion to meet certain parameters, for example a FSBS in the range of 110-160 while on the gtts.

I feel like we are just becoming robots and free thinking is going out the window. I'm sorry, I just had to vent somewhere. What's going to be next? New protocols to titrate vasoactive drugs? I don't know. I wish my hospital would just give the Joint Commission the boot :mad:

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Specializes in ER, ICU.

Hey don't give them any ideas... I wonder what the cost to health care is of all this compliance?

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My hospital made the switch to the insulin drip protocol several years ago and it has worked out fine. It is not so different from a heparin drip protocol.

There is more emphasis these days on patient safety, and a side effect of that is that decisions requiring judgement are more standardized.

I remember the days of concentrated potassium vials at the bedside for dialysis, very concentrated Morphine used to make our own Morphine drips and other practices that are disappearing for patient safety reasons.

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My hospital will be instilling this new Joint Commission Insulin gtts protocol in my ICU. I was just wondering if anyone out there has had to use their new protocol yet, being a requirement now?

I'm a little disgruntled about it. The new protocol now includes insulin boluses and a table to determine the next insulin dose for that hour on the gtts.

I thought things were working fine when we nurses titrated the insulin drip based on our discretion to meet certain parameters, for example a FSBS in the range of 110-160 while on the gtts.

I feel like we are just becoming robots and free thinking is going out the window. I'm sorry, I just had to vent somewhere. What's going to be next? New protocols to titrate vasoactive drugs? I don't know. I wish my hospital would just give the Joint Commission the boot :mad:

Tighter control of glucose levels will be achieved with the drip. They are taking the liability out of your hands-what rate for 110-160-2 units, 3 units, ? There probably were incidences where there were thoughts that "on our discretion" meant that you were practicing outside your scope i.e. prescribing medicine like an LIP (MD, NP, PA, etc.)

just my 2 cents.

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Specializes in Burn, CCU, CTICU, Trauma, SICU, MICU.

I have always used protocols at every hospital I have worked in. One hospital had a pharmacy controlled computer program that you would type in your blood sugar, and it would give you the rate to change your gtt to based on the patients entire hospital stay's trends, titrating down to a tenth of a unit sometimes. it was extremely effective.

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Specializes in ICU/CCU.

My hospital has always used a protocol for insulin drips. We recently switched protocols to one that is a little more confusing than the old one, but still it's not rocket science. Am I to understand that the Joint Commission has one particular protocol that all hospitals are supposed to adopt, rather than just requiring that a hospital have some protocol in place? If so, that sounds a bit draconian.

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Specializes in Post Anesthesia.

Do anyone have a link to the Joint Commission protocal? I didn't know JC got that specific in thier requirements. We use a fairly simple protocal that works well and is easy to follow. Our endocrine group was using a different protocal that was 2-3 pages long and included a dozen different tables with multiple steps in each table. It worked better for glucose control but was so complex that at least half the time the nurse ended up running the drip at the wrong rate. We did have one doc who ordered "titrate as needed to keep glucose between..." The problem was no two nurses even came close to the same titration. Many times the less skilled ended up with roller-coster sugars, others took 12 hrs to get the glucose in range. Insulin is a hot button item for JC, always has been. The rule that every insulin dose be double checked by 2 nurses (yeh sure) has been around since the 1980s. It was just a matter of time before drip protocol came under thier watchful eye.

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Specializes in Emergency Nursing, Clinic Nursing.

We too use the protocol for insulin drips. I think is it great, set the pump for an hour and then recheck and change the drip. I work in the emergency room, so having something that beeps to remind you of something is great. I am a new grad so I never used any but this method.

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Specializes in Oncology.

I've never heard of a JCAHO specific insulin protocol. We're still using out hospital specific one. 110-160 seems a bit high for targets for an insulin gtts. Our target is 80-130.

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Specializes in Cardiac, ER.

We've used a protocol for many years. It's all on a computer program,..enter the glucose level, the target and DKA vs Non DKA and the program tells you where to start your gtt then beeps when it's time for the next accu check.

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Specializes in Critical Care.

My hospital has had an insulin gtt protocol for years. Its called Endotool. It is really annoying, but its safe and effective.

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