J Clin Outcomes Manage
Transitioning postoperative cardiovascular surgery patients from intravenous to subcutaneous insulin: an improvement project
Hemerson P, Banarova A, Izakovic M, Clancy GM, Richenbacher WE, Beireis L
ABSTRACT: Objective: To describe an improvement project to transition postoperative cardiovascular surgery patients from intravenous to subcutaneous insulin. Methods: A multidisciplinary team of hospitalist physicians, nurses, and a clinical pharmacist in collaboration with the cardiothoracic surgeon developed an evidence-based intervention using a time-point protocol. We evaluated glycemic control by analyzing the percentage of blood glucose levels < 180 mg/dL during postoperative day 1 and 2 before and after the intervention. Results: The average percentage of blood glucose measurements < 180 mg/dL increased from 38% to 59% (P = 0.08). The average blood glucose level achieved in the pre-intervention group was 203 mg/dL (± 73; median, 196 mg/dL); this decreased to 181 mg/dL (± 72; median, 158 mg/dL) (P = 0.10) after the intervention. Conclusion: Although there was no statistically significant improvement observed in postoperative blood glucose levels, our results reveal a trend towards improved glycemic control. Subjectively, our project enhanced provider awareness of the importance of maintaining glycemic control in post–cardiac surgery patients through successful collaboration with hospitalist consultation and a multidisciplinary team approach.
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