Improving the Transition from Intravenous to Subcutaneous Insulin in Critically Ill Hospitalized Patients

Many critically ill patients experience hyperglycemia as a result of physiological stress or as a consequence of diabetes mellitus. Once the condition of the critically ill hospitalized patient has stabilized, it is imperative to transition this patient from intravenous to subcutaneous insulin. The American Association for Clinical Endocrinologists, the American College of Endocrinologists and the American Diabetes Association have all provided guidelines for this transition process.A quality improvement project was conducted by a team of Master of Science in Nursing (MSN) students from the University of San Francisco at a metropolitan medical center in California. The team created and implemented an evidence-based protocol for transitioning hospitalized patients from intravenous to subcutaneous insulin. Due to time limitations and the vast scope of the project, the team was unable to fully implement the protocol. The team did conduct a microsystem assessment, root cause analysis, and literature review, and authored a final draft of the evidence-based transition protocol. Future MSN cohorts will engage in full implementation and evaluation of the protocol, which will include staff education and training, integration into the electronic health record and data collection regarding the protocol’s effectiveness.