Abstract
The new decision support tool Glucosafe 2 (GS2) is based on a mathematical model of glucose and insulin dynamics, designed to assist caregivers in blood glucose control and nutrition. This study aims to assess end-user acceptance and usability of this bedside decision support tool in an adult intensive care setting. Caregivers were first trained and then invited to trial GS2 prototype on bedside computers. Data for qualitative analysis were collected through semi-structured interviews from twenty users after minimum three trial days. Most caregivers (70%) rated GS2 as convenient and believed it would help improving adherence to current guidelines (85%). Moreover, most nurses (80%) believed that GS2 would be timesaving. Nurses' risk perceptions and manual data entry emerged as central barriers to use GS2 in routine practice. Issues emerged from the caregivers were compiled into a list of 12 modifications of the GS2 prototype to increase end-user acceptance and usability. This usability study showed that GS2 was considered by ICU caregivers as helpful in daily clinical practice, allowing time-saving and better standardization of ICU patient’s care. Important issues were raised by the users with implications for the development and deployment of GS2. Integrating the technology into existing IT infrastructure may facilitate caregivers’ acceptance. Further clinical studies of the performance and potential health outcomes are warranted.
Similar content being viewed by others
Abbreviations
- BG:
-
Blood glucose
- EE:
-
Energy expenditure
- EN:
-
Enteral nutrition
- GS2:
-
Glucosafe 2
- PN:
-
Parenteral nutrition
- ICU:
-
Intensive care unit
References
Callahan LA, Supinski GS. Hyperglycemia-induced diaphragm weakness is mediated by oxidative stress. Crit Care. 2014;18(3):R88.
Ekpe K, Novara A, Mainardi JL, Fagon JY, Faisy C. Methicillin-resistant Staphylococcus aureus bloodstream infections are associated with a higher energy deficit than other ICU-acquired bacteremia. Intensive Care Med. 2014;40(12):1878–87.
Wischmeyer PE, Puthucheary Z, San Millan I, Butz D, Grocott MPW. Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise. Curr Opin Crit Care. 2017;23(4):269–78.
Kotagal M, Symons RG, Hirsch IB, Umpierrez GE, Dellinger EP, Farrokhi ET, et al. Perioperative hyperglycemia and risk of adverse events among patients with and without diabetes. Ann Surg. 2015;261(1):97–103.
Krinsley JS. Glycemic control in the critically ill—3 domains and diabetic status means one size does not fit all! Crit Care. 2013;17(2):131.
Clain J, Ramar K, Surani SR. Glucose control in critical care. World J Diabetes. 2015;6(9):1082–91.
Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003;78(12):1471–8.
Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591–600.
Schefold JC, Bierbrauer J, Weber-Carstens S. Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock. J Cachexia Sarcopenia Muscle. 2010;1(2):147–57.
Ali NA, O'Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008;178(3):261–8.
Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring ≥14 days of mechanical ventilation. Crit Care Med. 2003;31(5):1373–81.
Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, Nollet F, van Schaik IN, Schultz MJ, et al. Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study. Crit Care. 2015;19:196.
Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, de Heer G, Heller AR, Kampa U, Mayer K, Muhl E, Niemann B, Rümelin ASS, Stoppe C, Weimann A, Bischoff SC. DGEM Guideline “Clinical Nutrition in Critical Care Medicine”. Aktuel Ernahrungsmed. 2018;43:341–408.
McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN. 2016;40(2):159–21111.
Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79.
Rood E, Bosman RJ, van der Spoel JI, Taylor P, Zandstra DF. Use of a computerized guideline for glucose regulation in the intensive care unit improved both guideline adherence and glucose regulation. J Am Med Inform Assoc. 2005;12(2):172–80.
Taylor BE, Schallom ME, Sona CS, Buchman TG, Boyle WA, Mazuski JE, et al. Efficacy and safety of an insulin infusion protocol in a surgical ICU. J Am Coll Surg. 2006;202(1):1–9.
Eslami S, Abu-Hanna A, de Keizer NF, Bosman RJ, Spronk PE, de Jonge E, et al. Implementing glucose control in intensive care: a multicenter trial using statistical process control. Intensive Care Med. 2010;36(9):1556–655.
Chase JG, Andreassen S, Jensen K, Shaw GM. Impact of human factors on clinical protocol performance: a proposed assessment framework and case examples. J Diabetes Sci Technol. 2008;2(3):409–16.
Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: what is "best achievable" practice? An international multicenter observational study. Crit Care Med. 2010;38(2):395–401.
Pielmeier U, Rousing ML, Andreassen S, Nielsen BS, Haure P. Decision support for optimized blood glucose control and nutrition in a neurotrauma intensive care unit: preliminary results of clinical advice and prediction accuracy of the Glucosafe system. J Clin Monit Comput. 2012;26(4):319–28.
Pielmeier U, Andreassen S, Juliussen B, Chase JG, Nielsen BS, Haure P. The Glucosafe system for tight glycemic control in critical care: a pilot evaluation study. J Crit Care. 2010;25(1):97–104.
Riddersholm SPJ, Rousing ML, Pielmeier U, Andreassen S. Lowering of blood glucose and its variability by computerized decision Support. Clinical diabetes technology meeting April 20–21, 2012; Los Angeles, USA.
Vogelzang M, Zijlstra F, Nijsten MW. Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit. BMC Med Inform Decis Mak. 2005;5:38.
Stewart KW, Chase JG, Pretty CG, Shaw GM. Nutrition delivery, workload and performance in a model-based ICU glycaemic control system. Comput Methods Programs Biomed. 2018;166:9–18.
Pachler C, Plank J, Weinhandl H, Chassin LJ, Wilinska ME, Kulnik R, et al. Tight glycaemic control by an automated algorithm with time-variant sampling in medical ICU patients. Intensive Care Med. 2008;34(7):1224–300.
Dubois J, Van Herpe T, van Hooijdonk RT, Wouters R, Coart D, Wouters P, et al. Software-guided versus nurse-directed blood glucose control in critically ill patients: the LOGIC-2 multicenter randomized controlled clinical trial. Crit Care. 2017;21(1):212.
Abu-Samah A, Knopp JL, Abdul Razak NN, Razak AA, Jamaludin UK, Mohamad Suhaimi F, et al. Model-based glycemic control in a Malaysian intensive care unit: performance and safety study. Med Devices. 2019;12:215–26.
Hallbeck MS, Koneczny S, Buchel D, Matern U. Ergonomic usability testing of operating room devices. Stud Health Technol Inform. 2008;132:147–52.
Heidegger CP, Graf S, Perneger T, Genton L, Oshima T, Pichard C. The burden of diarrhea in the intensive care unit (ICU-BD). A survey and observational study of the caregivers' opinions and workload. Int J Nurs Stud. 2016;59:163–8.
Glaser BGSA. The constant comparative method of qualitative analysis. The discovery of grounded theory: strategies for qualitative research. New York: Aldine DeGruyter; 1967.
Aragon D. Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control. Am J Crit Care. 2006;15(4):370–7.
Blaha J, Barteczko-Grajek B, Berezowicz P, Charvat J, Chvojka J, Grau T, et al. Space GlucoseControl system for blood glucose control in intensive care patients—a European multicentre observational study. BMC Anesthesiol. 2016;16:8.
Berger MM, Revelly JP, Wasserfallen JB, Schmid A, Bouvry S, Cayeux MC, et al. Impact of a computerized information system on quality of nutritional support in the ICU. Nutrition. 2006;22(3):221–9.
Bousie E, van Blokland D, van Zanten ARH. Effects of implementation of a computerized nutritional protocol in mechanically ventilated critically ill patients: a single-centre before and after study. Clin Nutr ESPEN. 2016;11:e47–e54.
Ettori F, Henin A, Zemmour C, Chow-Chine L, Sannini A, Bisbal M, et al. Impact of a computer-assisted decision support system (CDSS) on nutrition management in critically ill hematology patients: the NUTCHOCO study (nutritional care in hematology oncologic patients and critical outcome). Ann Intensive Care. 2019;9(1):53.
van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc. 2006;13(2):138–47.
Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 2004;11(2):104–12.
Gephart S, Carrington JM, Finley B. A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record. Nurs Adm Q. 2015;39(4):345–56.
Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293(10):1197–203.
Sittig DF, Singh H. Defining health information technology-related errors: new developments since to err is human. Arch Intern Med. 2011;171(14):1281–4.
Reynolds TL, DeLucia PR, Esquibel KA, Gage T, Wheeler NJ, Randell JA, et al. Evaluating a handheld decision support device in pediatric intensive care settings. JAMIA Open. 2019;2(1):49–61.
Dabliz R, Poon SK, Ritchie A, Kuan K, Penm J. The digitization of the ICU: an evaluation of usability and hospital-wide acceptability. Stud Health Technol Inform. 2019;264:566–70.
Acknowledgements
The authors thank all the GS2 users for their participation in the study. We also thank Dr. Shellie Boudreau for language editing.
Funding
Financial support came from the institutional research fund of intensive care (Department of Anaesthesiology, Pharmacology and Intensive Care—APSI) and from AAU Proof of Concept at Aalborg University, Denmark.
Author information
Authors and Affiliations
Contributions
AW participated in the study design, trained the caregivers, screened and included the patients, collected, analysed and interpreted the data, and drafted the manuscript. UP participated in the study design, protocol and questionnaire, trained caregivers, participated in the setting up of the study, developed the software and drafted the manuscript. SG conceived the study protocol, design and questionnaire, participated to the setting up of the study and drafted the manuscript. NS contributed to the study design, protocol, and questionnaire and to setting up the study and revising the manuscript. BP implemented the software, was responsible for the IT support and participated to setting up the study. SA conceived the study protocol, design and questionnaire, contributed to the software development and revised the manuscript. CPH, as responsible part, conceived the study protocol, design and questionnaire, trained the caregivers, obtained funding, analysed and interpreted the data, and drafted the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
A de Watteville (AW), U Pielmeier (UP), S Graf (SG), N Siegenthaler (NS) and B Plockyn (BP) declare that they have no conflict of interest. S Andreassen (SA): board member of Judex Datasystems AS, Treat Systems ApS, OBI Medical AS and Amphi Systems, none being related to the present study. CP Heidegger (CPH): received restricted research Grants from Fresenius Kabi and Nestlé, none being related to the present study.
Ethical approval
The Ethics Committee of Geneva University Hospital decided that there was no need for approval for this project according to the art. 2 of the law on research on the human being (“Loi relative à la recherché sur l’être humain”).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
de Watteville, A., Pielmeier, U., Graf, S. et al. Usability study of a new tool for nutritional and glycemic management in adult intensive care: Glucosafe 2. J Clin Monit Comput 35, 525–535 (2021). https://doi.org/10.1007/s10877-020-00502-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-020-00502-1