Nurse practitioner–mediated intervention for preoperative control of diabetes in elective surgery patients

Abstract

Purpose This study evaluated the effect of nurse practitioner (NP) mediated interventions on diabetes control before elective surgery. Data sources A program was initiated to improve preoperative diabetes control in patients with HbA1c > 8%. The intervention was initially mediated by a physician alone and subsequently changed to involve NPs. The goal of intervention was fasting blood glucose (BG) <200 mg/dL on the day of surgery (DOS). Data were collected before the program (control group), during physician‐mediated intervention (phase 1), and during NP‐mediated intervention (phase 2). Conclusions There were 222 patients in the control group, 226 in phase 1, and 160 in phase 2. Mean BG (mg/dL) on DOS was 171.4 ± 66.5 in control group, 162.6 ± 58.1 in phase 1, and 153.4 ± 46.6 in phase 2 (p = NS for control vs. phase 1 and <0.01 for control vs. phase 2). More patients received an intervention in phase 2 (93%) than in phase 1 (75%). Among those receiving intervention, 87% achieved target BG in phase 2 and 82% in phase 1 (p = NS). Duration of diabetes, baseline HbA1c, time available before surgery, and diabetes intervention were independent predictors of achieving target BG. Implications for practice NP‐mediated interventions increased access to care and resulted in lower BG levels and may be a good strategy for preoperative diabetes control.

Glucose management team significantly improves glycaemic care and commitment to in‐hospital guidelines within arthroplastic patients

“…Previous studies have shown promising results on in-hospital glucose management teams [13][14][15][18][19][20][21][22] : Retrospective analyses suggest that they improve access to care and glycaemic control but reduce readmissions and duration of the inpatient period 13,15,[18][19][20] and of costs. 21 Prospective studies are few: Wallaert and co-writers studied 38 surgical patients with vascular disease and showed that the involvement of a glucose management team improves glycaemic care.…”

Development of Quality Measures for Inpatient Diabetes Care and Education Specialists: A Call to Action

“…Despite the lack of evidence specific to traditional metrics of productivity such as patient volumes and time spent with patients, many articles speak to the clinical and financial outcomes of inpatient DCES practice, such as the following:Reductions in length of stay (LOS), 7-12 Readmission rates and emergency department visits, 8,10,11,13-21 Medication adherence, 17 andImprovements in glycemic metrics such as A1C, hypoglycemia, and hyperglycemia during and after discharge. 10,22-26 …”

Preoperative optimization of diabetes

“…The availability of these laboratory values in patients seen in preoperative clinics makes this an ideal screening tool to identify possible undiagnosed patients. Once a patient with hyperglycemia is identified in either setting, prompt referral to a multidisciplinary diabetes management team can help improve glycemic control as well as outcomes such as hospital length of stay 11,46…”

“…Once a patient with hyperglycemia is identified in either setting, prompt referral to a multidisciplinary diabetes management team can help improve glycemic control as well as outcomes such as hospital length of stay. 11,46 As admitted patients often experience periods of fasting during their hospital stay, this may also present an opportunity to screen for diabetes in preoperative patients with a fasting blood glucose level. 47 Given that patients often have blood glucose levels taken during routine lab draws, identify fasting levels to then act on for preoperative evaluation could provide useful information at no extra cost to patients.…”