Poster Presentation
Thursday, 20 July 2006
10:00 AM - 10:30 AM
Thursday, 20 July 2006
3:00 PM - 3:30 PM
This presentation is part of : Poster Presentations II
Implementation of a Multidisciplinary Nurse Directed Glycemic Control Initiative
Anne Muller, RN, MSN, CNS, NP, Surgical Nursing, Hospital of the University of Pennsylvania, Phila, PA, USA and Cynthia Hartman, RN, MSN, CRNP, Medical Nursing, Hospital of the University of Pennsylvania, Phila, PA, USA.
Learning Objective #1: Identify three steps essential to successful implemetnation of a nurse led multipdisciplinary glycemic control program.
Learning Objective #2: Discuss patient safety issues pertinent in treating inflammatory disease processes.
Purpose: This multidisciplinary initiative was an effort to implement a nurse driven glycemic control protocol for surgical patients in an acute care tertiary institution. Purposes included improved postoperative outcomes such as, reduced post-operative deep sternal wounds infections (DSWI) rates, identification of previously non-diagnosed hyperglycemic patients and increased nurses’ knowledge and implementation of evidence-based practice (EBP). Significance: DSWI cost $80,000 per case, increased length of stay and contribute significantly to spiritual distress. Background: In the United States DSWI is estimated to occur in 0.8% to 2% of patients undergoing procedures using a median sternotomy operative approach, including coronary and valvular procedures, heart and lung transplant and aortic repair. Controlling hyperglycemia during the intraoperative and immediate post-operative course improves the standard of care provided. Description: A multi-disciplinary task force was formed with representation from nursing administration, the clinical nurse specialist (CNS) group and nursing education. One CNS wrote the evidenced-based protocol, serving as the lead person for the pilot program and the institution wide implementation. The evidence-based protocol stated inclusion criteria, monitoring parameters, directives for maintaining normoglycemia and hypoglycemia treatment algorithms utilizing a continuous insulin infusion. Once initiated, the protocol continued for 72 hours post operatively. Outcomes:  Process outcomes include adherence to the protocol. Outcome data include the average three-day blood glucose, percentage of newly identified hyperglycemic patients and DSWI rates. Conclusions: The leadership and expertise of the CNS is essential for promoting evidence based practice, process improvement and collaboration throughout the continuum of care. Implications for practice: The work process challenges associated with multiple measurements of blood glucose and the teaching needs of newly diagnosed hyperglycemic patients are enormous. CNS involvement assures interdisciplinary collaborations, communication and development of the systems needed for protocol implementation in complex systems and improved patient outcomes resulting in higher quality and more cost-effective care. 

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