Optimization of Perioperative Blood Glucose Levels in Patients with Diabetes

Abstract

Problem: Perioperative hyperglycemia places surgical patients with diabetes at higher risk for developing surgical site infections and poor surgical outcomes. Anesthesia and perioperative nursing leadership at a Mid-Atlantic hospital identified concern regarding blood glucose monitoring practice and optimization during the perioperative period, with only 26.6% glucose evaluation during the intra-operative period, and 40% remained hyperglycemic in the post-operative period. Purpose: The purpose of this quality improvement project was to implement an evidence-based Perioperative Blood Glucose Management guideline over a 15-week period at a Mid-Atlantic hospital to improve blood glucose practices during the intra and post-operative period among adult patients with diabetes undergoing outpatient surgery. Methods: A practice guideline was approved by anesthesia leadership and formal education sessions were then provided to anesthesia and nursing staff. The guideline was placed in each operating room and at nursing stations for reference. Implementation barriers were tracked weekly and addressed by the Project Lead. Re-education, presence and facilitation, feedback, and incentives increased staff adherence and project sustainability. Data was collected weekly via chart audits to determine guideline adherence rates and post- operative blood glucose optimization, defined as 70mg/dL to 180mg/dL. Results: A total of 238/ 238 eligible adult patients with diabetes undergoing outpatient surgery were included. The average intra and post-operative guideline adherence rate was 79.1% and 47%, respectively. The average post-operative glucose optimization rate was 90%. Conclusions: This practice change is a feasible, practical, evidence-based solution to improve quality, safety, and outcomes. Overall findings suggest that instituting a guideline can increase perioperative glucose monitoring, allow for earlier recognition of hyperglycemic or hypoglycemic episodes, and increase post-op blood glucose optimization rates.