Implementation of an Evidence-Based Protocol for Blood Glucose Management in Critically Ill Adult Patients: A Pilot Study.

The study was a before-and-after pilot in one ICU, so other changes over time could explain the differences. The patient comparison used 34 patients before and 27 patients after, which is small. The implementation period lasted three months, and the authors say this may have been too short to show larger patient outcome effects. Nurses' knowledge, attitudes and behaviour were self-reported, and the audit was done by two ICU nurses from the research team. The intervention was a bundle: protocol, hospital information system flowchart, insulin infusion and adjustment rules, recommended monitoring frequencies, a monitoring record sheet, patient and family brochures, a training programme and repeated audits, so the contribution of any single component cannot be separated. The protocol depended on local resources such as continuous glucose monitors, so it may not transfer unchanged to other units. The study did not randomise participants, and no blinding is described.

Do not conclude that the protocol itself caused the patient changes. The study was a before-and-after pilot in one ICU, and implementation also included a hospital information system flowchart, an insulin infusion and adjustment protocol, recommended indications and glucose detection frequencies, a glycaemic monitoring record sheet, patient and family brochures, a training programme and repeated audits, so the contribution of any single component cannot be separated.