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Protocol improves diabetes management by Sarah McLaughlin Public Relations A new diabetes protocol could affect countless areas of medical care.    The Hospital Diabetic Task Force (HDTF) was created in September 2003 “to serve as hospital leader for safe and effective diabetes management,” said Kathie Hermayer, M.D., associate professor, Divison of Endocrinology and chairperson of the task force. Its members come from various areas of MUSC including nursing, dietary, lab medicine, pharmacy, medical house staff, hospitalists, and quality management.   One of the task force’s many initiatives is to improve insulin infusion in critical care. In the past, MUSC tried several initiatives, but were unsuccessful. After significant buzz about aggressive diabetes protocols, MUSC attempted to implement them; but these did not work either. One possible explanation for this is the research and testing done to create such protocols are generally done on Caucasians, and cannot apply to the largely African-American patient population at MUSC.    After trying numerous time-intensive protocols, the task force decided to approach the problem from a different angle. This time, they turned to nurses for help.    “Nurses in the ICUs intuitively know an awful lot about intensive care principles. They have an absolute level of competency and are highly professional,” said Tim Hushion, R.N., one of the nurses who contributed to the development of the new protocol. Hushion emphasized that using multi-disciplinary input leads to higher success rates.   Frank Kerr, R.N., and Hushion took this idea to Michael Irving, Clinical Information Services director, and after empowering the nurses new ideas soon developed.   Beginning with evidence-based medicine, the team worked toward two initiatives: one for the floor and one for the ICU.    Besides Hermayer, Hushion, and Kerr, others working on the ICU initiative included: John Kratz, M.D., Pam Arnold, R.N., Lisa Kozlowski, R.N., Jeremy Soule, M.D., Jimmy Alele, M.D., Jyotika Fernandes, M.D., Soonho Kwon, M.D., Sherif Yacoub, M.D., Christina Cox, M.D., Angela Sutton, M.D., Brian Cumbie, M.D., Beatrice Janulyte, M.D., Bob Anthony, R.N., and Donna Sheppard-Smith.   The hard work resulted in a new online calculator multiplier concept, a type of computer software that typically costs around $100,000 to $150,000. However, the team wanted to develop the software specifically for MUSC and then pilot the software with MUSC patients. This goal was met with doubt from many, due to the size of such a challenge and its level of difficulty. Nonetheless, the software was developed.    “People always ask us, ‘How did you do this?’”  Hermayer said.  A key to the success of the HDTF was administrative support from medical director John Heffner, M.D., Department of Medicine chair Jack Feussner, M.D., Outcomes and Quality Management's Rosemary Ellis and Shirley Brown.    The ICU protocol is based on evidence that if blood sugar (glucose) is controlled at 80-120, the number of blood transfusions, mortality rates, patients in need of dialysis, and the duration of ICU stay all decreases. Reportedly, ICU mortality went down 42 percent.   Besides Hermayer, Arnold, Hushion,  and Kozlowski, the floor initiative was driven by Patrick Cawley, M.D., Bonnie Foulois, R.N., Roz Smith, R.N., and endocrinology attendings and fellows. This protocol involves an algorithm approach to keeping glucose between 100 and 150. The floor IV-drip protocol was piloted on 8-East at MUSC. Physician and nursing feedback resulted in aborting the 8 East floor initiative.      The goal for the ICU protocol (calculator/multiplier concept) is to implement it in other units to benefit various patients who need glucose management. These would include the critically ill, post-surgical patients, transplant, surgery step-down, cardiology/cardiothoracic units, labor and delivery, and 8 East.    Friday, Nov. 4, 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.