Abstract
Purpose
The purpose of this project to evaluate adherence to the perioperative hyperglycemic
protocol among Certified Registered Nurse Anesthetists (CRNAs) at a large academic
hospital. A secondary objective of this project is CRNAs' perceptions of barriers
to point-of-care (POC) testing and the protocol.
Design
A quality improvement project.
Methods
Using Donabedian's conceptual framework, a Phase 1 retrospective chart analysis of
297 patients with diabetes undergoing non-cardiac surgery before and after implementing
POC testing for intraoperative glucose control was performed. Only patients with preoperative
BG ≥ 180 mg/dL were included in this phase of the project, which involved a comparison
of the protocol utilization before and after implementation of POC testing. Phase
2 included an assessment of CRNA's perceptions of the protocol.
Findings
The final sample included 91 (37 preimplementation; 54 postimplementation) participants.
There were no significant demographic differences between the groups. Overall, 52.7%
of patients had intraoperative glucose checks, and only 16.5% received insulin. Preoperative
BG levels decreased 11.4-points, and postoperative BG levels increased 20.4 points
when comparing pre-and postimplementation groups. However, there were significant
differences in postoperative glucose levels, pre-and postimplementation. The survey
showed that the majority (65.5%) of CRNAs identified difficulty locating the protocol
as the primary barrier to utilization.
Conclusions
Although all patients included in this project qualified for an intraoperative glucose
check, findings revealed that only half of the patients had a glucose check and less
than one fifth of the patients received insulin treatment, indicating poor adherence
to the protocol. Thus, while implementing protocols is essential, utilization and
adherence to the protocol are critical to improving patient outcomes. Recommendations
for continued improvement include increasing protocol accessibility, staff training,
compliance monitoring, and a more simple protocol structure.
Keywords
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References
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). National diabetes statistics report: estimates of diabetes and its burden in the United States. 2020. Accessed May 15, 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
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Article info
Publication history
Published online: December 16, 2022
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: None to report.
Identification
Copyright
© 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
