Abstract Background Systemic corticosteroids remain the cornerstone of therapy for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), yet they frequently induce hyperglycemia, which has been associated with increased infection risk, longer ICU stay, and higher mortality. Despite awareness, glycemic excursions during IV steroid therapy often go unaddressed due to inconsistent insulin practices. A multidisciplinary quality improvement (QI) initiative was developed to reduce steroid-induced hyperglycemia through a standardized insulin protocol, collaborative nurse-pharmacist-endocrinology oversight, and real-time glucose monitoring in ICU patients admitted with AECOPD. Methods A pre-post interventional QI project was conducted in a 20-bed medical ICU between January and September 2024. The baseline period (January-March) included all AECOPD patients receiving IV methylprednisolone or equivalent. During the intervention phase, a standardized insulin management protocol was introduced, co-developed by the critical care and endocrinology teams. The protocol emphasized early initiation of basal-bolus insulin, predefined correction thresholds, and nurse-driven glucose monitoring every four hours, with automated alerts triggered for values exceeding 180 mg/dL. Pharmacists participated in daily rounds to review ongoing steroid tapers and insulin dose adjustments, while weekly multidisciplinary meetings provided feedback on performance metrics and compliance. The post-intervention phase (June-September) evaluated changes in the incidence of hyperglycemia (180 mg/dL), hypoglycemia (70 mg/dL), ICU length of stay (LOS), and adherence to the protocol, using chi-square and t-tests for comparison. Results A total of 164 ICU admissions for AECOPD were analyzed (78 pre-intervention and 86 post-intervention). Baseline characteristics were similar between groups (mean age 66 ± 9 years, 54% male, mean BMI 29 kg/m²). The incidence of steroid-induced hyperglycemia decreased from 48% to 26% (p 0.01) following protocol implementation. The mean ICU LOS was reduced by 0.8 days (5.3 → 4.5 days, p = 0.04). There was no increase in hypoglycemia events (4.1% vs. 3.8%, p = 0.89). Protocol adherence exceeded 90% by month four, and staff satisfaction surveys reflected improved clarity in insulin titration workflow and interdisciplinary communication. Conclusion A standardized, nurse-driven insulin protocol collaboratively managed by critical care, pharmacy, and endocrinology teams significantly reduced steroid-induced hyperglycemia in ICU patients with COPD exacerbations without increasing hypoglycemia risk. This initiative highlights the impact of pulmonary-endocrine collaboration in enhancing medication safety, optimizing glycemic control, and improving ICU efficiency. This abstract is funded by: none
Pugazhendi et al. (Fri,) studied this question.