Optimizing the Patient with Diabetes Undergoing Surgery in the Preoperative Setting

Abstract

Problem: Dysglycemia during the perioperative setting contributes to unfavorable surgical outcomes of increased hypermetabolic state, inflammation, and increased risk for infection. Glucose management is at provider discretion in the preoperative setting at a small community hospital. Blood glucose level monitored within three hours of surgery in 78% of patients and when monitored in the postoperative unit, 10.8% are hyperglycemic. Purpose: The purpose of this Quality Improvement initiative was to implement and evaluate the effectiveness of a preoperative glucose monitoring guideline over 14 weeks, among inpatients with diabetes undergoing surgery to change practice and improve glycemia throughout the perioperative period. Methods: A project team was mobilized to plan an initiative to implement a glucose monitoring guideline. Stakeholder buy-in was achieved by sharing current practice data and best clinical practices. The practice change was integrated into routine preoperative care for all eligible patients with visual aids and change champions to monitor glucose and administer treatment. Data on adherence and glucose optimization rates (70 mg/dL to 200 mg/dL) were tracked, analyzed, and communicated on a weekly basis with the site. Weekly oversite was provided to mitigate barriers and promote facilitators of practice change. Results: Adherence to the protocol was 82.5%, 82% of inpatients with diabetes undergoing surgery had optimized blood glucose levels prior to entering the operating room, and 89% were optimized in the postoperative unit. Patterns in the data show that when the preoperative glucose monitoring guideline was adhered to, glucose levels were more likely to be optimized throughout the perioperative period. Conclusions: The use of a preoperative glucose monitoring guideline is effective in standardizing blood glucose monitoring in the preoperative unit which can contribute to the optimization of blood glucose levels throughout the perioperative period.