Optimizing Pre-operative Glucose Levels in Patients with Diabetes Using Glucose Management Guideline

Abstract

Problem: Diabetes is a common comorbid condition among surgical patients, yet explicit guidelines on management in the perioperative period are vague. In an outpatient surgical department at a midsized hospital, 86.1% of patients with diabetes have a glucose level checked pre-operatively and 17.4% have blood glucose levels >180mg/dL entering the operating room. Currently, treatment of hyperglycemia is variable based on individual provider judgement. Purpose: The purpose of this quality improvement project was to implement and evaluate the effectiveness of a pre-operative glucose management guideline over 15 weeks for patients with diabetes in an outpatient surgical setting. Methods: This guideline required blood glucose level assessments on all surgical outpatients with diabetes and defined interventions based on glucose results and patient factors. Pre-operative glucose levels and insulin administration for eligible patients were collected from reviews of electronic medical records weekly to determine guideline adherence and pre-operative blood glucose optimization. Staff was updated at the end of each week with data and additional staff education was provided when negative trends were noted. Leadership buy-in from the beginning helped to continue forward project momentum. Results: Guideline adherence averaged 84.7% (66.7-100%) with 100% adherence in weeks 7, 10, and 13. Glucose optimization at baseline was 82.6%, compared to 87.6% (63.2-100%) thereafter. Conclusions: A standardized blood glucose management guideline for surgical outpatients with diabetes standardizes the assessment of glucose levels in this population, but optimization of those levels remain variable. Increased monitoring for diabetic patients remains a valuable outcome. Many medical, surgical, and pharmacologic factors contribute to the glucose levels of diabetic patients. A standardized guideline may help to address one piece of this complex puzzle.