Blood glucose management for patients in the perioperative and interventional services areas was inconsistent, leading to both hypoglycemic and hyperglycemic events. Hypoglycemia can cause seizures, falls and even death, while hyperglycemia exacerbates the long-term sequelae of cardiac disease, kidney disease, neuropathy and impaired wound healing. A patient’s length of stay can also increase with uncontrolled blood glucose. An interprofessional team formed in September 2020 to better direct the care of patients with diabetes and pre-diabetes for nursing, advanced practice providers (APPs) and physician partners.
The Adult Perioperative/Interventional Services Blood Glucose Management Protocol was created and disseminated in May 2021 on the 7 Tower OR and 4T Interventional Platform, outlining interventions for prior-to-day-of-surgery and preoperative, intraoperative and postoperative areas. Included in the protocol was an easy-to-use algorithm depicting the steps to take when managing blood glucose and a helpful patient education guide. In conjunction with the protocol, Epic order sets were built to manage blood glucose. While working to complete the protocol, the team highlighted and rectified processes in jeopardy. The team also put processes in place to foster communication between nursing and endocrine APPs while helping to revise the outdated insulin pump policy.
Partnering with the Knowledge Management Team, a dashboard was built that highlights the key metrics relevant to this protocol and the management of blood glucose. Using this dashboard, the team can view retrospective and current data to ascertain if the protocol is having a positive impact on key metrics. As outlined in the protocol, intervention is initiated when a patient has a blood glucose over 200. An organizational goal for patient care is that time elapsed from when a patient receives a blood glucose check to insulin administration is 60 minutes or less.
During the three months prior to the protocol going live in May 2021, 244 patients in the perioperative area had a blood glucose greater than 200. Of those patients, 52 received insulin within 60 minutes of a blood glucose check (21.3%). During the three months after the protocol went live, 244 patients in the perioperative area had a blood glucose greater than 200, but the number of those patients who received insulin in a timely manner doubled to 104 patients (42.6%).
A strength of this project was the interprofessional collaboration and partnerships formed in which everyone played a role in fostering exemplary professional practice.