Re: Portland Protocol

We started this in our facililty. Several things happened....Number one, the step-down nurses were none to happy about the time spent doing blood sugars and adjusting drips. The second thing is that when the patients moved out of the unit and started eating we saw a major highs and lows in their glucose control. Of course the normal response after eating is that the blood sugar goes up...then we increase the drip and the blood sugar bottoms. After several weeks of this, it was decided that patients would be on the drip after surgery and when they moved to the step-down unit they went to q4hours FSBS and sliding scale insulin.

My CCU has pre printed standing glycemic protocol orders for all vent patients and any others whose condition warrants it.

Pros: no guessing regarding what to do with a blood sugar value

fewer phone calls to docs

better glucose control

better outomes for the patient

Cons: increased staffing needs with these patients (not an issue in CCU)

if you don't know the trend of your patient, the required protocol can have you making adjustments and then giving D50 to compensate for the low glucose levels (I often say I'm using the Melissa glycemic protocol, if I feel I know my patient and refuse to increase or decrease the drip for a glucose level that is 1-5 points above or below the desired number)

increased documentation requirements, obviously

if your unit has limited numbers of glucometers, time is wasted trying to find one every 15-30 minutes for your patient

If I think of anything else, I'll post again

Melissa

We have the Portland here also, but it is only in the ICU. Our tele nurses are not expected to handle that, their patient turn around is too great to allow them the time to take care of that. We have very specific rules, so yes there are less calls and less questions to ask, but I have found that sometimes there are patients that stay on it too long.

Just a quick follow up.........

The reason that it seems that they are on too long is b/c you can have someone that is on say 0.5 units an hour and then off the drip and then on

.25 units and so on until they are off. At this point we should be just taking them off and starting sliding scale, but on nights it doesn't always happen that quickly.