Degree Awarded Date
December 15, 2023
Background and Review of Literature: Diabetes Mellitus (DM) is a complex metabolic disorder characterized by hyperglycemia leading to adverse outcomes. There is an association between dysglycemia and adverse perioperative outcomes. Evidence-based research supports consistent blood glucose (BG) monitoring and narrow glycemic parameters for surgical patients in the perioperative setting. Implementing and adhering to a glycemic guideline can help improve patient outcomes and decrease hospital costs.
Purpose: This quality improvement project (QIP) aims to determine the barriers to anesthesia clinicians implementing the perioperative glycemic management guideline for BG levels greater than 180 mg/dL. Then, develop an educational component to increase anesthesia clinicians’ adherence to the glycemic management guideline.
Methods: Data for the project were obtained from retrospective pre/post-education chart reviews and pre/post-surveys. Quantitative methods were used to measure adherence to appropriate treatment of BG over 180 mg/dL based on Appendices 5, 6, and 7 of the institution’s perioperative glycemic management guideline.
Implementation Plan/Procedure: An educational PowerPoint that provided instruction on Appendices 5, 6, and 7 of the glycemic management guideline and addressed the top three barriers to adhering to the guideline was created and distributed to the department via email. Additional education included roving in-services targeting anesthesia clinicians caring for surgical PWD in the operating room.
Implications/Conclusions: Adherence to Appendices 5, 6, and 7 of the glycemic management guideline is inconsistent by anesthesia clinicians at BJH. While literature may vary on one exact perioperative glycemic management guideline to follow, adhering to an evidence-based targeted
BARRIERS IN PLACE TO ANESTHESIA CLINICIANS 5
BG range during surgery was found to improve patient outcomes. The QIP determined barriers in place to adhere to Appendices 5, 6, and 7 of the glycemic management guideline and provided education to anesthesia clinicians on utilizing the guideline, where to find them in the clinical protocols, and why they should be consistently followed.
Spencer, Julie DNP, RN, CDCES (Chair) Barnes Jewish College, Goldfarb School of Nursing
Torres, Brian DNP, CRNA (Committee Member) Barnes Jewish College, Goldfarb School of Nursing
Wolfe, Rachel PharmD, MHA, BCCP (Committee Member) Washington University School of Medicine in St. Louis
Frydrych, Neil and Marshall, Meghan, "Addressing Barriers to Anesthesia Clinicians Utilization of the Perioperative Glycemic Management Guideline in Adult Surgical Patients with Diabetes at a Level 1 Midwestern Trauma Center" (2023). Doctor of Nursing Practice (DNP) Student Projects. Paper 13.