Nurse-Led Implementation of a Safe and Effective Intravenous Insulin Protocol in the ICU


Khalaila and the team observed that hyperglycemia and resistance to insulin are common complications among critically ill patients. The observation confirmed the conditions even in patients with no history of diabetes mellitus (Khalaila et al., 2011). The recent evidence cited in past research shows that tight glucose controls are linked to inadequate clinical outcomes for adults in the ICUs. Therefore, the findings informed the choice of the topic of study, which is the safe use of the Intravenous Insulin Protocol in the medical ICU.

Background of the Study

The effect of blood glucose levels on treating patients in the ICU has been studied extensively. In particular, controlling sugar levels through insulin is associated with increased mortality among patients in ICU. Therefore, other studies have focused on understanding the connection between the use of insulin in controlling blood glucose levels and the rise in deaths from ICU admissions. The importance of such findings would be confirmed in guiding the nursing practice on the safe and effective use of insulin in managing patients admitted for intensive care.

Secondly, through the information, nurses would understand the optimal glucose levels in the blood for the different in-patients to reduce mortality rates. The study by Khalaila and the team also sought to confirm the effective procedures by nurses to implement the intravenous insulin protocol. The study was guided by the objective of evaluating the effectiveness and safe practice of administering insulin to maintain optimal blood glucose levels among ICU patients.

Methods of Study

The study involved developing a nurse-led “intravenous insulin protocol” to target glucose levels in patients at 110 to 149 mg/dl. The protocol defined hypoglycemia as when the blood glucose level fell below 70 mg/dl. Consequently, the Hadassah Hospital Jerusalem was used as the study area. The patients admitted to the ICU who required insulin infusion were enrolled in the study and divided into protocol and control groups. The procedures were then observed and evaluated in terms of effectiveness and patient safety. The glucose levels recorded would then be defined as low, moderate, high, and extremely high. The patients’ records and charts were used to collect data for the study. Finally, the descriptive statistics were generated through the SPSS software, and the results were presented in percentages, median, and standard deviation.


The study established that the hypoglycemia condition was rare in the protocol group, and none of the cases had adverse consequences. However, the hypoglycemia events were more frequent in the control group. On the other hand, more cases of hyperglycemia occurred in the control group than in the protocol setup. Nevertheless, after the implementation of the protocol, no significant reduction in mortality, dialysis, and mechanical ventilation was observed. Therefore, the general finding from the study was that the nurse-led intravenous insulin protocol was more effective and safe when used in ICU patients.

Moreover, the results would have particular significance, and implications for nursing as using insulin protocols could enhance the autonomy and empower the nurses. Besides, nurse-led intravenous insulin protocol was considered to increase the patient’s discomfort as glucose measurements would increase. Therefore, the findings would influence nursing education and practices as more such studies would be necessary for effective ICU management. However, the findings had significant input on the observation and control of blood sugar levels in patients within the ICU.

Ethical Considerations

The study is considered to have observed ethical standards strictly at all levels. Firstly, the institutional review body approved the research and data collection from the patient’s records (Zahedi et al., 2013). Secondly, data privacy was highly esteemed as the research teams safeguarded the hospital records. Besides, the patients’ names would be concealed after classification into the protocol and control groups. Through such efforts, the study ensured that the patient’s privacy was protected. However, one would raise the ethical concern based on the frequent blood glucose tests for the patients because the procedure is usually painful and would continue exposing them to more suffering (Zahedi et al., 2013). Moreover, ethical concerns would also arise by not seeking the patient’s consent to participate in the study.


As it is evident from the procedural research by Khalaila’s team, one could confirm that the conclusions made were justifiable. Firstly, the study was objective, as illustrated by the aims and the adoption of quantitative methodologies. Secondly, the researchers sought authorization from the relevant body before engaging in the study. Accordingly, the results confirmed the effectiveness and safety of the nurse-led intravenous insulin protocol for ICU patients. Therefore, the findings contributed to nursing knowledge and could guide future studies in the discipline. Furthermore, the results could be useful in decision-making by nurses and the management teams in intensive care units. However, the researchers would be blamed for overlooking the ethical procedures in seeking patients’ consent while participating in the study.



Khalaila, R., Libersky, E., Catz, D., Pomerantsev, E., Bayya, A., Linton, D. M., & Sviri, S. (2011). Nurse-led implementation of a safe and Effective Intravenous Insulin Protocol in a Medical Intensive Care Unit. Critical Care Nurse, 31(6), 27-35. doi:10.4037/ccn2011934

Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A.,& Dastgerdi, M. V. (2013). The code of ethics for nurses. Iranian Journal of Public Health, 42(1), 1.


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