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Nursing staff puts dream into motion Editor's note: The following essay entitled “Simply Magnetic” won first place in the Celebrating Excellence Fair Nov. 17. For a listing of all the winners and information regarding the fair, visit http://www.musc.edu/catalyst/archive/2005/co11-25excellence.html. by Frank Kerr III, R.N. Information Services As an MUSC Medical Center nurse, I believe the pursuit of magnet status for our hospital will propel the growth of the nursing profession. Magnet status can morph nurses into proactive and catalytic components of the health care team.    Recently, the CTICU nursing staff harnessed its nursing education, practice, clinical judgment, and dream for excellence into a unified force to create a new Insulin Drip Protocol with the guidance of the Diabetes Management Service, Pharmacy Services, and CTICU director, John Kratz, M.D.   A new, algorithm-based protocol for the infusion of IV Insulin was piloted in August 2005 and quickly proved itself to be ineffective. One problem with the new protocol was that just about every patient required an exception to the pre-printed orders. As a result, the hypoglycemia protocol was used too often, and the suggested blood glucose parameters took much too long to achieve. This was the third insulin protocol that the nurses had to pilot that did not work and for at least one nurse, it was time to take a new approach.   It was a nurse who began a unit debate by posing the question, “If nurses are able to regulate blood glucose by titrating an insulin drip, and yet the protocols are not working, why not ask for the nurses’ help?”    A reply of “Well, what would you do?” sparked a discussion of ideas. Actually, the ideas were similar in theory and practice at several other teaching institutions, like the University of Maryland.   After several weeks of question and answer sessions with Tim Hushion, R.N., and the CTICU nurses, the new protocol was drafted. The physicians took nursing suggestions to write new orders and the rules were set.   Hushion, the diabetes educator, and myself solicited Michael Irving, Clinical Informatics, to program a Web-based insulin drip calculator. This idea would change nursing practice: the calculator simplified the rules, taking into account all of the exceptions. In response to the attending physician’s request, the calculator would alert nurses to page Diabetes Service and use the hypoglycemia protocol if the patient’s blood glucose was too low.   Following staff education for the new orders and the Web-based calculator in September 2005, and the tweaking of a new flow sheet to suit the nurses’ needs, the Insulin Infusion Orders with the Web-based calculator were trialed.   The results of the trial were overwhelming. Data collected in August and September proved the new protocol to be safe, effective, easy to manage, and above all, efficient in controlling patients’ blood glucose within an acceptable range in 2-3 hours.   Blood glucose values were obtained 670 and 1,545 times in August and September, respectively. In August, 25 percent of the values were within the target range of 80-120 mg/dL and 71 percent were greater than 120 mg/dL. In September, by contrast, 58 percent of the values were within the target range of 80-120 mg/dL and only 34 percent were greater than 120 mg/dL. The average blood glucose was 113.8 mg/dL.   The pilot ran for three weeks and proved to so beneficial that plans are underway to implement the protocol housewide.   What do you get when nurses empower themselves to change their practice?   The CTICU received collaboration and support from the medical staff to achieve one common goal. They changed the quality of their nursing practice. They created the idea of a Web-based calculator with which to enhance their practice, and found success in their hard work and efforts to provide better patient care.   This project defines the Magnet status. Friday, Dec. 2, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.