DOI

10.21007/con.dnp.2026.0153

Faculty Advisor

Tracy McClinton, DNP, APRN, AGACNP-BC, HGET-C, EBP-C

Document Type

Poster

Publication Date

Spring 5-5-2026

Disciplines

Critical Care Nursing | Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Quality Improvement

Abstract

Purpose/Background

Diabetic ketoacidosis (DKA) is a high-risk acute emergency requiring timely insulin titration, intensive monitoring, and coordinated interdisciplinary care. Traditionally, management relies on provider-driven insulin infusion adjustments, which may introduce delays and workflow inefficiencies. Emerging nurse-driven insulin infusion protocols aim to standardize care, improve safety, and enhance clinical efficiency. The purpose of this scoping review was to evaluate existing evidence comparing nurse-driven versus provider-driven insulin infusion protocols in the management of adult patients with DKA.

Methods

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From August 2023 through November 2025, literature was retrieved from CINAHL, PubMed, and Google Scholar using predefined search terms. Twenty-seven articles were identified, and six studies met inclusion criteria. Data were systematically extracted on study design, patient population, protocol characteristics, and clinical outcomes, including intensive care unit and hospital length of stay, time to DKA or anion gap resolution, hypoglycemia, and mortality. Outcomes were synthesized to identify overarching trends.

Results

The six included studies represented varied designs, including one systematic review, one controlled trial, one cohort study, and three descriptive or quality-improvement studies. Across studies, nurse-driven insulin infusion protocols demonstrated outcomes that were comparable to or improved relative to provider-driven approaches. Consistent findings included reductions in hypoglycemia and improved adherence to monitoring standards, with no evidence of increased mortality, prolonged length of stay, or delayed DKA resolution.

Implications for Nursing Practice

Findings suggest that nurse-driven insulin infusion protocols are a safe and effective alternative to provider-driven management of DKA. Implementation of standardized nurse-driven algorithms may enhance workflow efficiency, promote timely clinical decision-making, and support expanded nursing autonomy. These results support broader adoption of nurse-driven models and future DNP-led quality improvement initiatives to optimize DKA care delivery.

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