An Institutional Peri-operative Intravenous Insulin Infusion Algorithm: Evaluation and Recommendations
The purpose of this retrospective medical record analysis was to examine our non-cardiac surgery insulin algorithm for efficacy, safety and provider adherence. The sample included 132 hyperglycemic patients (standard group) that were placed on intravenous insulin infusions. Nineteen patients using insulin pumps at home that had been converted for surgery to intravenous infusions were separately studied. Efficacy, safety and adherence definitions were developed and data was extrapolated to address the research purpose.
Captured data did not reflect any incidences of blood glucose (BG) measurements <50 mg/dl; two BG were however <70 mg/dl in the standard group. In the standard group, 73% of patients achieved BG of 100-179 mg/dl and an 85% mean proportion of subsequent time within range (MPST) through the remaining peri-operative period. Algorithm adherence metrics were 54-58%. Lower time-weighted average BG (190 vs 206 mg/dl; p=.03) was achieved where providers adhered to the intravenous insulin maintenance table >67% of the time. In insulin pump patients, MPST was 81% after conversion to intravenous infusions.
Increased algorithm adherence was associated with improved peri-operative glycemic control. In insulin pump patients, successful conversion was attributed to glycemic nurse practitioner collaboration and algorithm reference. Algorithm modifications are proposed to increase adherence and safety.
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