Implementation of Glycemic Management Algorithm during the Perioperative Phase in Orthopedic Surgery

Abstract

Problem & Purpose: Perioperative hyperglycemia has been shown to increase the risk of surgical site infections in patients who undergo orthopedic surgery. A local hospital in the Mid-Atlantic region has a higher rank on the standardized infection ratio than the national, suggesting hospitals have a higher rate of actual infections. Thus, the hospital requested an evidence-based clinical algorithm to manage perioperative hyperglycemia in their adult patient population undergoing elective orthopedic surgeries. The purpose of the quality improvement project was to implement an evidence-based perioperative glycemic management algorithm in adult patients undergoing elective orthopedic surgery at the local hospital in the Mid-Atlantic region. Methods: This quality improvement project included implementing a glycemic management algorithm used by perioperative providers. Anesthesiologists, certified registered nurse anesthetists, and registered nurses were educated on the algorithm, and the algorithm was made available at all nursing and anesthesia stations. The update and concerns were discussed during the weekly huddle and posted on the education bulletin board. The population in this project included diabetic and non-diabetic adult patients undergoing orthopedic surgery. Patients under 18 years old, pregnant, or admitted to the intensive care unit were excluded from the project. Data collection included patients' demographics, hospital blood glucose, insulin administration, and length of stay. Univariant analysis including frequency, median, and percentages and run charts were utilized to measure the education trained and the algorithm compliance via Microsoft Office's Excel. Results: 80 % (16/20) of perioperative providers received protocol education and have accessed the algorithm by week 3 of the implementation. The mean glycemic management algorithm utilization compliance was 46.9 % (92/197). Additionally, 96% (189/197) of patients met the targeted serum glucose range of 70-200 mg/dL during the perioperative period. Conclusions: The overall findings suggest that the compliance of the algorithm and maintenance of target blood glucose between 70-200 mg/dL could be feasible to reduce postoperative complications in the perioperative setting.