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ORIGINAL ARTICLE • Rev. Bras. Enferm. 78 (1) • 2025 • https://doi.org/10.1590/0034-7167-2024-0098 linkcopy

Construction and assessment of the quality of a care protocol for insulin use in hospitalized children and adolescents

Construcción y evaluación de la calidad de un protocolo de atención para el uso de insulina en niños y adolescentes hospitalizados

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to develop and assess the quality of a care protocol for safe insulin use in hospitalized children and adolescents.

Methods: a methodological study developed in three stages: scoping review, protocol development, and quality assessment. The scoping review followed the JBI recommendations, using the PRISMA-ScR checklist. The protocol was constructed according to the Guide for the Construction of Healthcare Protocols, and quality assessment was carried out byjudges using AGREE II.

Results: the protocol achieved a quality rating of 94.4% in the scope and purpose domain; 90.4% in stakeholder involvement; 96.1% in rigor of development; 95.2% in clarity of presentation; 92.8% in applicability; 97.6% in editorial independence; and 92.8% for overall guideline assessment. Judges made suggestions, most of which were accepted.

Final Considerations: the protocol was constructed and assessed as a quality instrument recommended for use by healthcare professionals in the context of insulin therapy in pediatrics.

Descriptors:
Child; Adolescent; Insulin; Patient Safety; Hospitalization

Judge	Suggestion	Decision-making
Judge 1	Describe the insulin application sites better with illustrations.	Accepted and included illustration with application locations.
Judge 2	I believe that an interesting indicator for monitoring/auditing the post-implementation protocol is the presence of complications related to the insulin application technique.	Accepted.
Judge 3	I suggest modifying the topic that contains the appropriate technique for administering subcutaneous insulin: in a hospital environment, skin antisepsis is performed in a unilateral movement with two swabs of 70% alcohol or cotton soaked in 70% alcohol. Circular movements are no longer used.	Topic III, in description of care Change to: in a hospital environment, skin antisepsis should be performed with unilateral movements using 70% alcohol swabs or cotton soaked in 70% alcohol.
Judge 4	1. Include the order of air injection along with the observation of aspiration of NPH and regular insulins to facilitate handling; 2. I was unsure about the sentence that says in the observation that a pen is safer for health professionals, since most places do not use the safety needle for the pen, making it necessary to disconnect it, which creates more risk than the syringe; 3. I would reassess the following sentence in the text, perhaps including in the observation: 45-degree angle on the 6 mm needle and the order of absorption.	Accepted.
Judge 5	I suggest including in more detail the step-by-step process for administering insulin in pens as well as including the use of technologies related to safe practices in insulin therapy (i-port, CGM, insulin pump, etc.).	The suggestion to include the step-by-step guide for administering insulin using pens was accepted. However, it was not possible to include the technologies as they were not the focus of the protocol.
Judge 7	Regarding this topic (target audience), I believe it would be beneficial to the psychology professional involved. When dealing with children, the challenge is to ensure acceptance of the technique and adequate rotation.	As this is a protocol for preparing and administering insulin, it is believed that, as it is a technical procedure, the psychologist would not benefit from this protocol.

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Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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