Background: In healthcare today, a significant proportion of diabetic patients suffer from pain due to nerve radiculitis. One known treatment for chronic pain includes the use of steroid injections under fluoroscopic guidance. The use of steroids in diabetic patients comes with an increased risk of prolonged hyperglycemia after the procedure. Diabetic patients undergoing procedures with the use of steroids need to be properly screened to reduce their risk of prolonged hyperglycemia after the procedure.

Local Problem: A large outpatient interventional pain department within a large health organization experienced an increased number of diabetic patients for steroid injections. Lacking a standardized treatment protocol, all diabetic patients received treatment in the department based on provider preference causing variations in practice. Due to this reason, the department recognize the need for a screening guideline for all diabetic patients undergoing procedure with the use of steroids. The purpose of this quality improvement project was to implement a standardized treatment protocol that included the screening of all diabetic patients prior to undergoing any interventional procedure with the use of steroids.

Interventions: During the fall of 2018, a quality improvement project implemented a guidelinebased screening tool. The screening tool was used to screen all diagnosed diabetic patients to ensure they had a recent glycosylated hemoglobin (A1C) level of 9.0 or less within 90 days prior to the procedure and a random blood glucose of 250mg/dL or less on the day of the procedure. The incision criteria for screening included any patient scheduled for a procedure with an existing diagnosis of diabetes. After screening all diabetic, any patient with an A1C greater than 9.0 were reschedule to have their procedure after their blood sugar and A1C meet the guideline standard. They are also referred to the organization’s diabetes management program. An educational program was developed to train provider staff on the use of the screening tool. The screening tool questions were developed and incorporated in the electronic medical record to facilitate the practice change and maintain sustainability. A total of 10 providers in two interventional pain clinics (A and B locations) received education on the screening tool prior to implementation. During the eight-week project implementation timeline, the medical records of all scheduled diabetic patients for the interventional clinics were audited to ensure that they received screening with the tool prior to their steroid injection procedure.

Results: Location A had a total of 55 patients who met the project inclusion criteria over the 8week period. Staff compliance with using the screening tool was 96% over the 8-week period. Location B had a total of 43 diabetic patients who met the project inclusion criteria. Staff compliance with using the screening tool prior to patient procedure was 88% over the 8-week period.

Conclusions: The diabetic patient screening tool is beneficial for patients and providers. Decreasing prolonged hyperglycemic episodes in diabetic patients after the use of steroids will improve overall patient outcome for diabetic patients who undergo interventional procedure.