Consecutive Nursing #Shifts and the Risk of #Hypoglycemia in Critically Ill Patients Who Are Receiving Intravenous Insulin: A Multicentre Study

STUDY OBJECTIVES:Intensive care unit (ICU) nurses commonly work multiple consecutive 12-hr shifts that leave little time for sleep between work shifts. Working multiple consecutive shifts could compromise vigilance and patient care, especially with respect to managing high risk medications such as insulin infusions..

We identified patients who had hypoglycemia (glucose <=3.5mmol/l, 63 mg/dl) between December 2008 and December 2009 in 3 ICUs in Vancouver, British Columbia..

..RESULTS:282 hypoglycemic events were identified in 259 patients. For 191 events we were able to identify one or more control shifts. Compared to nurses who had not worked a shift in the preceding day, the odds ratio of a hypoglycemic event was 1.68 (95% CI: 1.12,2.52), 2.16 (95% CI:1.25,3.73), and 2.54 (95% CI: 1.28,5.06) for nurses who were working their 2nd, 3rd, or 4th consecutive shift respectively.

CONCLUSIONS:Working multiple consecutive nursing shifts is associated with increased risk of hypoglycemic events in ICU patients.