Automated Insulin Infusion for Critically Ill Patients Potentially Faster, Safer Than Manual Calculation


Smart agent systems designed to automate insulin dose selection for critically ill patients could potentially optimize the safety and efficiency of insulin infusion practices in intensive care unit settings, according to a study published in BMJ Quality & Safety. The researchers said this system may reduce errors and provide faster insulin delivery when compared with manual dosing calculation, as well as providing nurses and clinicians more time to focus on other patient care priorities.

Currently, insulin infusion requires careful management of hourly insulin doses based on the patient’s condition, administered and overseen by a nurse. Because neither the patient's medical record nor the infusion pump's operating data communicate electronically, the nurse must begin by retrieving the patient's blood glucose level from the health record.

Then, they are required to manually calculate the medication rate change using an algorithm to determine the new insulin dosage. A second nurse double checks this process before it's documented in the medical record, and finally, the new dose is manually programed into the infusion pump to administer insulin to the patient.

“Glucose management improves outcomes for critically ill patients; however, current insulin infusion protocols are work-intensive for nurses and may be error prone,” said Michael Rosen, PhD, MA, associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, in a press release.

In the current study, 20 critical care nurses tried a specific smart agent system in a simulation-based setting between May 2018 and July 2018. Participants completed 12 mock situations in 4 blocks of 3 scenarios each. Each block was performed with either the manual protocol or smart agent. The nurses were surveyed after each session to get their impressions of safety levels, efficiency, perceived workload, trust in the system, and usability.

According to the researchers, the study found that the automated system was significantly better in dosing accuracy calculation compared with manual calculation. Across 120 scenarios, the nurses never made a calculation error when using the smart agent system compared with 20 errors made using the manual system. Further, the smart agent allowed the nurses to complete this process an average of 29 seconds faster than the existing manual system, while also reducing their overall workload.

The smart agent received positive remarks from all 20 nurses, who found that they trusted it more than doing the manual calculations after using it at least twice. Overall, 18 nurses found the smart agent easier to use than manual calculation, and 15 considered it safer than the manual process, with the remaining 5 either unsure or believing that both systems were about as safe.

“This approach can be applied to improve a fragmented and inefficient health care IT infrastructure through design, testing and system integration,” said Adam Sapirstein, MD, associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, in the release.


Research news tip sheet: Story ideas from Johns Hopkins Medicine [news release]. EurekAlert; May 12, 2021. Accessed May 14, 2021.

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