Evaluating the Utilization of a Perioperative Hyperglycemic Protocol: A Quality Improvement Project

Area of Science:

• Anesthesiology
• Quality Improvement
• Healthcare Management

Background:

• Perioperative hyperglycemia management is crucial for surgical patients with diabetes.
• Adherence to established protocols ensures optimal patient outcomes.
• Point-of-care (POC) testing aims to improve intraoperative glucose control.

Purpose of the Study:

• To evaluate adherence to the perioperative hyperglycemic protocol by Certified Registered Nurse Anesthetists (CRNAs).
• To identify CRNAs' perceptions of barriers to utilizing point-of-care (POC) testing and the protocol.

Main Methods:

• A quality improvement project using Donabedian's framework.
• Phase 1: Retrospective chart analysis of 297 patients with diabetes undergoing noncardiac surgery.
• Phase 2: Survey assessing CRNAs' perceptions of protocol barriers.

Main Results:

• Only 52.7% of eligible patients had intraoperative glucose checks; 16.5% received insulin.
• Postoperative glucose levels were significantly higher in the post-implementation group.
• 65.5% of CRNAs cited difficulty locating the protocol as a primary barrier.

Conclusions:

• Adherence to the perioperative hyperglycemic protocol was poor, indicating a need for improvement.
• Recommendations include enhancing protocol accessibility, staff training, and simplifying the protocol structure.
• Improving protocol utilization is critical for better patient outcomes in perioperative glucose management.