Patterns of Hand Grip Strength and Detection of Strength Loss in Patients Undergoing Bone Marrow Transplantation: A Feasibility Study.

PURPOSE/OBJECTIVES: To determine the feasibility of measuring hand grip strength (HGS) daily in a population of recipients of bone marrow transplantation (BMT), to describe changes in strength measured by HGS, and to describe relationships between laboratory values (hematocrit, hemoglobin, and absolute neutrophil count) and HGS.
. DESIGN: Prospective, longitudinal, repeated measures, within subject.
. SETTING: Inpatient units at the University of Washington Medical Center in Seattle.
. SAMPLE: 33 patients admitted in preparation for BMT or for complications from BMT.
. METHODS: HGS measured on admission and daily.
. MAIN RESEARCH VARIABLES: HGS, absolute neutrophil count, hemoglobin, and hematocrit.
. FINDINGS: Participants found HGS testing to be relatively easy. Average time to complete testing was 7.2 minutes (SD = 1.95). Nineteen experienced 20% or greater decline in HGS during hospitalization, with nine experiencing decline during the conditioning phase. Age, gender, and hemoglobin correlated with HGS. Strength loss was more likely in those undergoing allogeneic compared to autologous BMT.
. CONCLUSIONS: A majority of patients experienced strength decline during BMT, with a subgroup declining during conditioning. A positive relationship existed between HGS and hemoglobin and hematocrit in participants admitted for conditioning for BMT.
. IMPLICATIONS FOR NURSING: Weakness increases risk for falls. Patients may experience as much as 50% strength loss during the course of hospitalization for BMT. Strength loss occurs in the conditioning phase for some patients.

Use of serum and plasma glucose measurements as a benchmark for improved hospital-wide glycemic control.

OBJECTIVE: To demonstrate the benefit of an institutionally implemented glucose control intervention based on serum and plasma glucose values in the acute inpatient setting. METHODS: In a retrospective analysis, all serum and plasma glucose values from the laboratory information system database from 1999 through 2005 were used to assess implementation of 2 new hospital-wide intravenous and subcutaneous protocols aimed at lowering blood glucose values without increasing the number of hypoglycemic events. In our analysis, we used both a per-patient hyperglycemic index (HGI), an area-under-the-curve analysis, and hospital-wide geometric mean blood glucose to assess glucose control. Bedside capillary blood glucose measurements were not included. RESULTS: More than 630,000 serum and plasma glucose results were available for analysis. The percentage of results above the protocol target of 180 mg/dL decreased from 16.4% before the intervention to 10.0% after the intervention (P<.00001), and we found no change in the proportion of "critical" hypoglycemic results (<50 mg/dL). The hospital-wide geometric mean decreased significantly and coincided with a significant decrease in the fraction of patients with poor glucose control (based on the HGI) from 27.6% to 18.7% (P<.00001). The geometric mean blood glucose was found to be an excellent marker for the HGI (r2 = 0.99). CONCLUSION: We are the first to report improvements in glucose control over an extended period with use of both hospital-wide intravenous and subcutaneous insulin protocols in an academic hospital setting. Furthermore, hospital-wide mean blood glucose levels are excellent surrogates for the more comprehensive calculation of per-patient HGI.

New insulin infusion protocol Improves blood glucose control in hospitalized patients without increasing hypoglycemia.

BACKGROUND: Aggressive treatment of hyperglycemia in hospitalized patients can improve clinically important outcomes. At the University of Washington Medical Center a quality improvement project was conducted to develop and implement a standardized insulin infusion protocol for use throughout the institution. METHODS: The insulin infusion protocol was piloted on critical and non-critical care inpatient units. Safety and efficacy data were collected for a one-month period on each unit. RESULTS: A total of 156 patients were evaluated. The incidence of hypoglycemia was lower for the study group than the historical controls, as was the mean percentage of time patients were hyperglycemic, 15% +/- 2.3% vs. 33% +/- 2.6% for the critical care subgroup (p < .0001) and 18% +/- 2.4% vs. 56% +/- 2.3% for the non-critical care subgroup (p < .0001). CONCLUSIONS: The insulin infusion protocol better met the insulin requirements of our patients and achieved better glycemic control than previous protocols at the institution. In addition, there was no increase in hypoglycemia despite the use of the protocol in non-critical care units with higher patient-to-nurse ratios, suggests that insulin infusion therapy can be safely used outside of critical care units.