Pharmacy Management of Postoperative Blood Glucose in Open Heart Surgery Patients: Evaluation of an Intravenous to Subcutaneous Insulin Protocol

Stahnke, Amanda M.; Struemph, Kelly; Behnen, Erin M.; Schimmelpfennig, Julia

doi:10.1310/hpj4902-164

Hosp Pharm

2014

DOI: 10.1310/hpj4902-164

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Pharmacy Management of Postoperative Blood Glucose in Open Heart Surgery Patients: Evaluation of an Intravenous to Subcutaneous Insulin Protocol

Amanda M. Stahnke

Kelly Struemph

Erin M. Behnen

et al.

Abstract: Though differences were not found in compliance with SCIP postoperative day 1 and 2 measures, fewer sternal wound infections and hypoglycemic episodes were reported, indicating that the pharmacy protocol may have a positive impact on patient outcomes.

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Cited by 2 publications

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Transitioning Safely from Intravenous to Subcutaneous Insulin

Kreider

Lien

2015

Curr Diab Rep

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The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease.

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Transitioning Safely from Intravenous to Subcutaneous Insulin

Kreider

Lien

2015

Curr Diab Rep

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Decision Support Tool to Improve Glucose Control Compliance After Cardiac Surgery

Fedosov

Dziadzko

Dearani

et al. 2016

AACN Advanced Critical Care

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Hyperglycemia control is associated with improved outcomes in patients undergoing cardiac surgery. The Surgical Care Improvement Project metric (SCIP-inf-4) was introduced as a performance measure in surgical patients and included hyperglycemia control. Compliance with the SCIP-inf-4 metric remains suboptimal. A novel real-time decision support tool (DST) with guaranteed feedback that is based on the existing electronic medical record system was developed at a tertiary academic center. Implementation of the DST increased the compliance rate with the SCIP-inf-4 from 87.3% to 96.5%. Changes in tested clinical outcomes were not observed with improved metric compliance. This new framework can serve as a backbone for development of quality control processes for other metrics. Further and, ideally, multicenter studies are required to test if implementation of electronic DSTs will translate into improved resource utilization and outcomes for patients.

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Pharmacy Management of Postoperative Blood Glucose in Open Heart Surgery Patients: Evaluation of an Intravenous to Subcutaneous Insulin Protocol

Abstract: Though differences were not found in compliance with SCIP postoperative day 1 and 2 measures, fewer sternal wound infections and hypoglycemic episodes were reported, indicating that the pharmacy protocol may have a positive impact on patient outcomes.

Cited by 2 publications

References 10 publications

Transitioning Safely from Intravenous to Subcutaneous Insulin

Transitioning Safely from Intravenous to Subcutaneous Insulin

Decision Support Tool to Improve Glucose Control Compliance After Cardiac Surgery

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