An Institutional Peri-operative Intravenous Insulin Infusion Algorithm: Evaluation and Recommendations

  • Tamra Dukatz, MSN, CRNA Beaumont Health
  • Emma Hurst, MSN, CRNA Beaumont Health
  • Mary Golinski, PhD, CRNA Oakland University
  • Solomon Rosenblatt, MD Beaumont Health
  • Alla Sakharova, MD Beaumont Health
  • James Van Loon, MS Beaumont Health

Abstract

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.

       

Author Biographies

Tamra Dukatz, MSN, CRNA, Beaumont Health

 Tamra Dukatz, MSN, CRNA is a staff nurse anesthetist at Beaumont Health in Royal Oak, Michigan and clinical faculty for Oakland University Beaumont Graduate Program of Nurse Anesthesia.  Pager: (248) 992-4741 Personal residence: 1278 Ashover Drive, Bloomfield Hills, Michigan 48304

Emma Hurst, MSN, CRNA, Beaumont Health
Emma Hurst, MSN, CRNA is a staff nurse anesthetist at Beaumont Health in Royal Oak, Michigan and clinical faculty for Oakland University Beaumont Graduate Program of Nurse Anesthesia
Mary Golinski, PhD, CRNA, Oakland University
Mary Golinski, PhD, CRNA is an assistant professor and the assistant director of Oakland University- Beaumont Program of Nurse Anesthesia, Rochester Hills, Michigan
Solomon Rosenblatt, MD, Beaumont Health
Solomon Rosenblatt, MD, Michigan Endocrine Consultants, is an assistant professor at Oakland University William Beaumont School of Medicine and practicing endocrinologist at Beaumont Health, Royal Oak, Michigan
Alla Sakharova, MD, Beaumont Health
Alla Sakharova, MD, Michigan Endocrine Consultants, is an assistant professor at Oakland University William Beaumont School of Medicine and practicing endocrinologist at Beaumont Health, Royal Oak, Michigan
James Van Loon, MS, Beaumont Health
James Van Loon, MS, is a biostatistician at Beaumont Health, Royal Oak, Michigan

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Published
2016-08-12
How to Cite
DUKATZ, MSN, CRNA, Tamra et al. An Institutional Peri-operative Intravenous Insulin Infusion Algorithm: Evaluation and Recommendations. Anesthesia eJournal, [S.l.], v. 4, n. 1, aug. 2016. ISSN 2333-2611. Available at: <https://anesthesiaejournal.com/index.php/aej/article/view/38>. Date accessed: 24 feb. 2020.
Section
Articles

Keywords

peri-operative; insulin; diabetes; glycemic; pump