TOPLINE:

Implementation of a “Purple Alert” protocol at a nurse practitioner (NP)-led outpatient clinic showed significant improvements in blood glucose levels in patients with hyperglycemic crisis.

METHODOLOGY:

• This quality improvement project utilized an evidence-based “Purple Alert” protocol for treating 39 adult patients (mean age, 44.3 years; 54% women; 56% Black; 31% White) with type 1 (28%) or type 2 (64%) diabetes and blood glucose levels ≥ 350 mg/dL using incremental doses of rapid-acting insulin, monitoring of basic metabolic profile, and oral hydration.
• The protocol was implemented by four NPs, along with essential staff, including patient care technicians, certified diabetes educators, care coordinators, and management staff.
• Data collection focused on initial blood glucose levels, interventions that were implemented, and a 20-month follow-up on blood glucose levels.
• Based on the documented data, patients were categorized into two groups: one for which the NPs adhered to the protocol and the other for which the NPs did not follow the protocol.

TAKEAWAY:

• Overall, the protocol was adhered to in the treatment of 12 patients.
• Blood glucose levels decreased significantly in both adherent (mean difference [MD], 77.8 mg/dL; P < .05) and nonadherent (MD, 81.6 mg/dL; P < .05) groups, though mean blood glucose levels in the adherent group aligned better with the target level of < 350 mg/dL.
• The mean elapsed time for the reduction of blood glucose levels was 66 minutes in the adherent group and 81 minutes in the nonadherent group; the levels declined at an hourly rate of < 100 mg/dL in 11 out of 12 patients in the adherent group and in 14 out of 27 patients in the nonadherent group.
• Reasons for nonadherence were administration of high doses of insulin, missed mealtime insulin doses by patients, discharge of patients before achieving the target blood glucose levels, late arrival or a high volume of patients, and an absence of documentation of oral hydration in 15 out of 39 cases.

IN PRACTICE:

“Ongoing use of the Purple Alert protocol will benefit both the clinic and the local health system by preventing avoidable ED [emergency department] visits and associated costs, while incurring minimal additional expenses for patient care,” the authors wrote.

SOURCE:

The study was led by Bela Patel, DNP, CRNP, AGNP-C, Acute Care, and Continuing Care Department, The University of Alabama at Birmingham School of Nursing. It was published online on October 31, 2025, in the Journal of the American Association of Nurse Practitioners.

LIMITATIONS:

The NP-led interprofessional clinic served as a teaching platform with frequent rotation of student providers, presenting challenges in maintaining consistent protocol implementation despite efforts to educate all providers and include protocol information in the clinic’s orientation manual. 

DISCLOSURES:

No funding information was reported in the study. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.