Transitioning Postoperative Cardiovascular Surgery Patients from Intravenous to Subcutaneous Insulin: An Improvement Project

• Published in: Journal of clinical outcomes management Vol. 18; no. 12; p. 563
• Main Authors: Hemerson, Phyllis, Banarova, Adriana, Izakovic, Martin, Clancy, Gregory M, Richenbacher, Wayne E, Beireis, Lori
• Format: Journal Article
• Language: English
• Published: Wayne Turner White Communications Inc 01-12-2011
• Subjects: Cardiology; Evidence-based medicine; Glucose; Heart surgery; Insulin; Parenteral nutrition
• ISSN: 1079-6533; 1938-1336

To describe an improvement project to transition postoperative cardiovascular surgery patients from intravenous to subcutaneous insulin. 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. 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. 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.