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Perioperative Glucose Management in the Cardiovascular Setting
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2019-05
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DNP Project
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Background: Approximately 20-40% of patients undergoing general surgery and 80% of patients undergoing cardiac surgery have perioperative hyperglycemia. Perioperative hyperglycemia is associated with increased incidence of wound infections, ventilator dependence, heart dysrhythmias and mortality. In addition, hypoglycemia is linked to an increase risk of myocardial infarction, seizures and death. The purpose of this project was to create a Clinical Practice Guideline for perioperative glucose management in the cardiovascular setting. Local Problem: At a small community hospital in Maryland, there was a difference in glucose management among anesthesia providers. The anesthesia department at this institution requested an insulin protocol for several surgical populations. Intervention: A literature review was conducted for supporting evidence for the CPG. The literature was then summarized into a clinical practice guideline. The project proposal was then submitted for a Non-Human Subjects Research determination. After a CPG was created, an anesthesia staff meeting was held and feedback on the CPG was collected via a Practitioner Feedback Questionnaire and Appraisal of Guidelines for Research and Evaluation II Tool. This data was collected and analyzed through the use of descriptive and correlative statistics. Results: There were two appraisers for the AGREE II tool (N=2). The results of the Appraisal of Guidelines for Research and Evaluation II Tool were 100% across the six domains and for overall assessment. The Practitioner Feedback Questionnaire was completed by sixteen anesthesia staff members, four were anesthesiologists (6%) and 12 were CRNAs (88%). The students received 100% return rate of the Practitioner Feedback Questionnaires (n=16). Conclusion: The literature review results indicate perioperative glucose management is beneficial in the cardiovascular setting. The CPG created for perioperative glucose management will help decrease postoperative complications.