Professional blog

Abstract

Purpose: The purpose of the quality improvement (QI) project was to improve blood glucose control (BG) in elective surgical patients with diabetes mellitus (DM) and its association with decreased morbidity.

Background: A community hospital operative 30-day outcome report revealed a concerning trend in morbidity for postoperative general and vascular surgery patients. Data analysis identified perioperative hyperglycemia as the common preoperative risk factor for increased postoperative morbidity in patient with DM.

Methods: A multidisciplinary team with representatives from nursing, surgical residents, anesthesia, infection control, and the quality department was assembled to determine corrective action and plan for implementation of the action. Educational seminars were conducted to promote awareness about hyperglycemia and postoperative morbidity in patients with DM to anesthesia, surgeons, residents and nurses. A standardized BG protocol was created for management of preoperative patients with DM. This management started by optimizing BG control at the preoperative evaluation for surgery by a nurse practitioner, BG levels drawn on the day of surgery, and the patient being followed postoperatively for optimal BG control on the nursing unit by a diabetic nurse specialist. An electronic medical record order set of the protocol was implemented and used for documentation.

Outcomes achieved: Data was captured using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) prospectively.  The data reviewed from April through June 20XX revealed there were a total of 83 patients with DM having elective general and vascular surgery with a morbidity of 19.27%. Metrics for adherence were measured by usage of the order set and monitoring postoperative morbidity outcomes in patients with DM. Morbidity was defined as a patient having one or more of the defined NSQIP postoperative occurrences (complications. Since implementation of the BG protocol in January 20XX there have been 93 elective general and vascular surgical patients with DM with a decrease in overall morbidity to 8%.

Conclusion: The goal of this QI project was to see a decrease in postoperative morbidity in patients with DM by implementing a protocol for perioperative BG level monitoring and treatment. The preliminary data shows that process change incorporating electronic tools into the daily work flow of nursing care and documentation along with attention to preoperative and postoperative BG monitoring can improve surgical outcomes in patients with DM.