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
Glycemic Control in the Post Surgical Joint Replacement Population
Janet A. Lewis, RN, MA, CNOR1, Callie Sue Craig, RN, BSN, CNOR1, and April Merrill, RN, BSN, BC2. (1) Surgical Services, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA, (2) EDIBA Diabetes Center of Excellence, INTEGRIS Baptist Medical Center - EDIBA Diabetes Center of Excellence, Oklahoma City, OK, USA
Learning Objective #1: state the prevalence of hyperglycemia in the total joint replacement patient population.
Learning Objective #2: list effective interventions for managing hyperglycemia in the total joint replacement patient population.
Introduction of clinical problem: Growing awareness that hyperglycemia is linked to surgical site infections led a large metropolitan community hospital interdisciplinary team to develop protocols targeting appropriate glycemic control for inpatients.  Targeting hip and knee total joint replacement patients, a two-week study of pre-operative, intra-operative and post-operative blood glucose levels was completed.  Significant findings led to the development of a standard protocol and follow-up compliance monitoring.  

The clinical question: 1) How prevalent is hyperglycemia in the total joint replacement patient population?  2) What is the recommended glycemic range during the perioperative period?  3) Would the establishment of a standard protocol be appropriate?  4) What processes would be necessary to measure effectiveness?  
Search for evidence:  Included review of current literature databases (CINAHL, Medline), recommended practices (American College of Endocrinologists) and expert endocrinology consultation.
 

Results: Approximately 40% of patients in this study had glucose levels above the recommended range (target blood glucose is 80-110mg/dl as defined by the American College of Endocrinologists).  Three of these patients were found to have undiagnosed diabetes. The results were presented at the Total Joint Replacement Center operations meeting and development of a glycemic protocol was approved.  The protocol was subsequently initiated in January 2005.  From January-July 2005, follow-up compliance monitoring revealed approximately 37% improvement in target blood glucose level maintenance, 17 patients with HgbA1C’s ≥ 6.7% and 6 patients newly diagnosed with diabetes mellitus.   

Implications for practice: Standard protocol deemed effective for identifying the need for and management of appropriate glycemic control.  Future implementations include extending the protocol to include all surgical inpatients, initiation during preadmission testing for glucose control and continued post-discharge follow-up. 
 
 

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