Research Proposal for Insulin Protocol in Trauma Patients

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Unit 9 Project: Final Research Proposal
A Multiple Regression Analysis of Insulin Usage Versus Non-treatment of Hyperglycemia in Non-diabetic Trauma Patients Jeana Santostefano

Kaplan University

NU 310-01: Nursing Research

March 5, 2008

A Multiple Regression Analysis of Insulin Usage Versus Non-treatment of Hyperglycemia in Non-diabetic Trauma Patients Abstract
Purpose: The goal of this study is to explore the relationship between insulin administration in non-diabetic patients and their average length of stay in the intensive care unit, versus those non-diabetic patients left to their bodies’ utilization of homeostasis to maintain euglycemia. Design: Longitudinal, experimental posttest-only.

Setting: Local, suburban regional level I trauma center’s trauma intensive care unit. Sample: 320 male and female trauma patients, between the ages of eighteen and thirty, without a known history of diabetes, and having an admission blood sugar greater than 150. Methods: Participants will be selected using a systematic probability sampling method. Blood glucose and insulin dosage value data, or lack there of, will be collected through the use of biophysiologic measures. Meanwhile, cost of care and length of stay will be obtained through systematic chart reviews. All data will be analyzed using multiple regression analysis. Implications for Practice: Cost-containment and decreased length of stay are essential to the future of health care, and nursing. Additionally, the elimination of unnecessary procedures for patients will assist in a decreased workload for nursing staff. Introduction

Working in the trauma intensive care unit, nurses encounter a large number of patient complications and abnormalities. One of the aforementioned abnormalities would be, that said patients having been involved in a traumatic event often present with certain elevated lab values. Often lab values may be abnormal based on the fact that their body has undergone a stressful occurrence. In fact, many patients, regardless of past medical history, are admitted with elevated blood glucose levels. Additionally, many patients admitted after suffering a traumatic event are incapable of providing medical information related to an inability to communicate effectively. Documented research has shown that glycemic control is essential to proper and timely wound healing. Due to these research findings, many hospitals have implemented protocols related to glycemic control and administration of insulin in hospitalized patients based on blood glucose values despite the possibility that the patient may not have a medical history inclusive of diabetes. Recently, there has been an increase in the trauma unit’s patient population that require insulin drips that are protocol driven in the absence of a medical diagnosis of diabetes. Of particular interest is the possibility that placing a patient on insulin too early in the admission phase may lead to a patient requiring insulin coverage when it would otherwise not be necessary. This research proposal seeks the answer to whether patients without a history of diabetes require insulin coverage at such an early stage of their traumatic rehabilitation. Under examination is whether patients’ blood sugar levels remain elevated for greater than twenty-four hours post-trauma, requiring medical intervention. This is an area of interest because it remains to be discovered whether insulin administration can be harmful to non-diabetics. Does insulin administration possibly cause the pancreas to slow its own natural production of insulin, thereby leading the patient to develop some form of insulin resistance? Furthermore, how tightly controlled do blood sugars need to be in the non-diabetic patient? Recently, many patients seem to have experienced prolonged stays in the trauma intensive care unit related to the fact that they require hourly blood glucose...
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