A Quality Improvement Project Addressing Perioperative Glycemic Guideline Adherence Samuel Q. Caldwell BSN, RN Laycie J. Lafler BSN, RN Elizabeth R. Stevens BSN, RN Background & Significance ● Impact of Diabetes: ○ 25% of the surgical population is diabetic and more likely to require a surgical procedure. ○ Glycemic control in diabetic and nondiabetic patients reduces the incidence of surgical site infections (SSI) by 50%. ○ Variability between organizations (AACE, ADA, SCCM, SAMBA, STS). ○ The annual cost of SSIs and sepsis is $3.3 billion and $24 billion in the United States, respectively. Problem Statement ● Teaching hospital in Mid-Michigan had identified an area for improvement where they were not meeting their ASPIRE measures associated with perioperative glucose management. ● Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) measures are being tracked but lack benchmark compliance of 90% or better. ● GLU-01, GLU-03, GLU-04 Gap Analysis Clinical Question Will the breakdown of an existing 21-page perioperative BG management protocol into three separate preoperative, intraoperative and postoperative algorithms improve ASPIRE measures adherence? SMART GOALS • Create and distribute newly developed preoperative, intraoperative, and postoperative blood glucose management protocol algorithms on the corresponding unit by June 15th, 2021. • Improve perioperative glucose management protocol compliance for GLU-01 by 5%, GLU-03 by 20%, and maintain 100% GLU-04 by August 31st, 2021. Literature Synthesis ● Target BG levels are more consistently achieved when perioperative BG protocols are utilized and result in less need of insulin dosing. ● Literature supports the use of supplemental tools (i.e. algorithms) to improve protocol adherence. ● The Literature ○ Proactive protocol-based management of hyperglycemia and diabetes in colorectal surgery patients (2018). ○ Blood glucose management for reducing cardiac surgery infections (2018). ○ Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol (2016). ○ Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery (2017). SWOT Framework The framework that guided this project was the Plan, Do, Study, Act (PDSA) cycle. Internal Review Board (IRB) ● The project was reviewed by Michigan State University’s IRB and was deemed non research. ● The anesthesia department liaison and hospital compliance officer reviewed and approved this quality improvement project. Intervention ● Developed BG management algorithms for the preoperative, intraoperative, and postoperative units. ● Introduced & provided education on new algorithms. ● Distributed algorithm copies in each respective area. ● Survey distributed to perioperative staff to identify barriers. ● Presented project findings and recommendations. Intraoperative Algorithm Intraoperative Algorithm (back) Timeline (GANTT) Data ● GLU-1: Glucose > 200, recheck glucose within 90 min or insulin given (Intraop). ● GLU-3: Glucose ˃200 with admin of insulin or glucose recheck within 90 mins (Periop). ● GLU-4: Glucose ˂60 with admin of dextrose or recheck within 90 mins (Periop). Strengths & Challenges Strengths: Challenges: - Leadership support - Access - An accepted need - Competing for growth projects - Staff enthusiasm - Feedback - Project presence Recommendations ○ Increase staff buy-in ○ Multiple change champions ○ More education ○ Presence of project change team during implementation Conclusions ● Lengthy protocols for perioperative BG management complicates the ability to meet goals. ● Breakdown and simplification of protocols should improve compliance. ● Use of newly established BG algorithms will lead to meeting the desired ASPIRE measures. Acknowledgements Thank you! Thank you! Thank you! ● Amanda Ahrens, MSN, Charge CRNA - Lead liaison ● Emily Eggleston, MSN, CRNA - Protocol/algorithm superuser ● Dr. Gayle Lourens, DNP, CRNA - Nurse anesthesia program director ● Holly Lockwood, RN - Quality improvement nurse ● Julius Sawyer, MSN, CRNA- Secondary liaison Questions? References Cheisson, G., Jacqueminet, S., Cosson, E., Ichai, C., Leguerrier, A. 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