Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control.

BACKGROUND Tight glycemic control is important in critically ill patients and involves insulin infusions and monitoring of blood glucose levels. Hourly measurements of blood glucose levels and adjustments of intravenous insulin doses require additional work by nurses. OBJECTIVES To evaluate the nursing work incurred with and nursing perceptions about tight glycemic control and blood glucose monitoring. METHODS A variety of intensive care units were studied. Surveys were used to gain information about nurses' perceptions. Time-in-motion observations were used to determine the time taken to measure blood glucose levels and adjust insulin doses. RESULTS Nurses thought that tight glycemic control was important and that the work associated with it was substantial. Nurses thought that easier and automated forms of blood glucose monitoring are needed. They preferred using an arterial catheter to obtain blood samples to avoid excessive finger sticks. The total number of blood glucose measurements was 77 954. The mean time taken for hourly blood glucose monitoring and adjustment of insulin doses was 4.72 minutes. The estimated costs of time spent on glycemic control during a 1-year period were $182 488 for nurses' salaries and $58 500 for supplies. CONCLUSIONS Although most nurses endorse tight glycemic control, the work associated with it is burdensome and costly. Because up to 2 hours might be required for tight glycemic control for a single patient in a 24-hour period, the costs in time and money are high. Easier clinical methods for monitoring blood glucose levels are needed.