Reinforcement of a Preoperative Insulin Protocol

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)

Matthew Newton (Creator)

Institution

The University of North Carolina at Greensboro (UNCG )

Web Site: http://library.uncg.edu/

Advisor

Angela Kabbe

Abstract: Purpose: Patients with type 1 diabetes (T1DM) often arrive for surgery with blood glucose readings out of target goal for the healthcare facility. This often leads to surgical delays, increased healthcare expenses and increases the risk of patient complications. The purpose of this project was to evaluate an institution’s preoperative insulin management protocol and reinforce its usage by providing an education session to the preoperative clinic providers. The ultimate goal is to improve blood glucose readings and better prepare the patient for surgery. A secondary aim of this study was to improve provider confidence by expanding comprehension of the current insulin protocol. Background: Glucose management for the patient with T1DM is a highly debated topic among medical providers. Too much or too little insulin can have dramatic effects on the patient’s health and wellness. Diabetes can significantly impact patient outcomes and healthcare expenses. Barriers to consider when educating advanced practice providers is their time, willingness to learn new information, obtaining buy in, and promoting future adherence to the protocol. Method: This was a quasi-experimental design quality improvement project. Documented blood glucose readings the morning of surgery were collected for a random 50 preoperative T1DM patients. Preoperative clinic providers were surveyed on their current understanding of the preoperative insulin management protocol, followed by an educational session explaining it in detail. Two months after the educational sessions another random 50 blood glucose levels of patients were selected for comparison. The same survey was distributed to the preoperative providers to assess for change in understanding of the use of the preoperative insulin management protocol. Results: The results showed no significant change in the pre-intervention and post-intervention blood glucose readings among patients with T1DM presenting for surgery. Even though the providers all stated positive levels of confidence with managing insulin preoperatively, and all cited the protocol as their resource for decision-making regarding preoperative insulin recommendation, the answers to the sample clinical questions asked in the survey showed that the protocol was not consistently being used correctly. Conclusion and Future Recommendations: There was limited interest and participation from the providers during this project which may have impacted the results and reduced its applicability to other settings. In the future, researchers would benefit from developing protocols with the input of the providers and fully engage with upper management to promote provider buy-in and greater adherence of the new program.

Reinforcement of a Preoperative Insulin Protocol
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Created on 2/14/2023
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Additional Information

Publication

Dissertation

Language: English

Date: 2022

Keywords

Preoperative Insulin Protocol, Type 1 Diabetes Surgery

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