Insulin Pump Therapy in the Perioperative Period: A Review of Care after Implementation of Institutional Guidelines

Boyle, Mary E.; Seifert, Karen M.; Beer, K; Mackey, Patricia A.; Schlinkert, Richard T.; Stearns, Joshua D.; Cook, Curtiss B.

doi:10.1177/193229681200600504

Cited by 19 publications

(21 citation statements)

References 9 publications

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“…[17][18][19][20] Recently, growing attention has been paid to the hyperglycemia control in perioperative patients with diabetes, and experience is gradually being accumulated in this regard. [21][22][23][24][25][26] In our hospital, CSII had been successfully applied to perioperative patients with diabetes for several years, and the management policy is similar to the guidelines published recently. 23 Our results show that there were lower levels and less fluctuation of glucose in the patients of the CSII group.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Cai

et al. 2013

Diabetes Technology & Therapeutics

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Background: Hyperglycemia is common and hard to control in surgical patients with diabetes. We retrospectively investigated short-term effects of continuous subcutaneous insulin infusion (CSII) in perioperative patients with diabetes. Patients and Methods: Perioperative patients with diabetes discharged between January 1, 2006 and January 1, 2012 were included. Glucose control and postoperative outcomes were compared between the patients using CSII or non-CSII insulin therapy. Results: We identified 108 pairs of patients matched by propensity and surgical category who were using CSII therapy (CSII group) or non-CSII insulin therapy (control group). The CSII group had significantly lower fasting glucose levels (on the first postoperative day, 9.06 -3.09 mmol/L vs. 11.05 -4.19 mmol/L; P = 0.003) and lower mean glucose levels (on the operation day, 9.93 -2.65 mmol/L vs. 12.05 -3.86 mmol/L; P = 0.001). The CSII group also had a lower incidence of fever (on the first postoperative day, 30.4% vs. 53.2%; P = 0.005). Furthermore, patients in the CSII group experienced significantly shorter postoperative intervals for suture removal (P = 0.02) and hospital discharge (P = 0.03). No significant difference in the total medical expenditure was observed between the two groups (P = 0.47). We also made a comparison between the 30 pairs of patients who were using CSII or multiple daily insulin injection therapy but observed no significant difference between these two therapies in glucose control or postoperative outcomes. Conclusions: Compared with non-CSII insulin therapy, even short-term implementation of CSII can improve the postoperative control of glucose, reduce the incidence of postoperative fever, and shorten the time for suture removal and discharge in surgical patients with diabetes.

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Section: Discussionmentioning

confidence: 99%

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Cai

et al. 2013

Diabetes Technology & Therapeutics

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“…2 Each phase of care was reviewed in the electronic medical record to determine whether the protocols required in the CPM had been followed. For purposes of this analysis, the 2 outcomes of primary interest were documentation of the device and performance of glucose monitoring during the different segments of the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

“…Emerging data indicate that insulin pumps can be safely allowed in the operating suites and may provide glucose control comparable to intravenous insulin infusions. [2][3][4] Individual institutions are now developing care process models (CPMs) to provide guidance on use of CSII during the perioperative phase of surgical care, 3,5 although some still recommend disconnecting the pump for procedures lasting longer than 3 hours. 6 Despite rising interest in this topic, consensus strategies for maintaining insulin pump systems during surgery continue to lag, and subspecialty organizations and experts remain silent on the topic.…”

mentioning

confidence: 99%

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

Mackey

Thompson

Boyle

et al. 2015

J Diabetes Sci Technol

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Objective: The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures. Methods: Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation. Results: We reviewed 45 cases on insulin pump therapy in the pre-CPM cohort and 106 in the post-CPM cohort. Demographic characteristics, categories of surgery, and perioperative times were not significantly different between the 2 groups. Recommended hemoglobin A1c monitoring occurred in 73% of cases in the pre-CPM cohort but improved to 94% in the post-CPM group ( P < .01). There was a higher frequency of documentation of the insulin pump during the preoperative, intraoperative, and postanesthesia care unit segments of care in the post- vs pre-CPM periods (all P < .01). The number of cases with intraoperative glucose monitoring increased (57% pre-CPM vs 81% post-CPM; P < .01). Glycemic control was comparable between the 2 CPM periods. Hypoglycemia was rare, with only 3 episodes in the pre-CPM group and 4 in the post-CPM. No adverse events associated with perioperative insulin pump use were observed. Conclusions: This analysis adds to previous data on use of insulin pump therapy during the perioperative period. Some processes require additional attention, but data continue to indicate that a standardized approach to care can lead to a successful and safe transition of insulin pump therapy throughout the perioperative period.

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“…During the six months after the policy was implemented, there were fewer recurrences of hypoglycemia as compared to the six months prior to the policy. That is, of the 30 patients in the pre-intervention group who had at least one hypoglycemic event, 56.7% [9] had a recurrent event, wheras of the 23 patients in the post-intervention period who had at least one hypoglycemic event, 52.2% [10] had a recurrent event [11]. The policy ensures that all patients admitted with CSII are assessed by the endocrinology consult team, utilize hospital insulin and glucometer systems, have three sets of infusion kits and complete a patient selfassessment with attestation forms indicating their understanding of the CSII policy.…”

Section: Introductionmentioning

confidence: 99%

“…Nurses are then required to document these values and the status of the patient's insulin pump infusion skin site. A year later, a peri-operative CSII pump policy was also devised in order to make patients aware of the CSII policy prior to surgery and to ensure that they brought extra supplies, set a temporary basal rate, or prepare by transitioning to SQ insulin in the case of long or late-day procedures [10,11].…”

Section: Introductionmentioning

confidence: 99%

Assessing Patient Satisfaction of ProvidersÃ¢ÂÂ Adherence to Inpatient Management with Continuous Subcutaneous Insulin Infusion (CSII) Policy: A Cross-Sectional Study

2015

J Diabetes Metab

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There are unique challenges in managing patients with Continuous Subcutaneous Insulin Infusion (CSII) in the inpatient setting, but these challenges may be mitigated by institutional protocols and staff education. The purpose of our study was to determine the current level of patient satisfaction with the staff's adherence with anthe insulin pump policy and to identify areas for improvement. We hypothesize that the majority of patients will be satisfied with inpatient CSII management, as our institute's insulin pump policy had been implemented with educational sessions one year prior. We created a 20-question survey to assess patient satisfaction in regards to their inpatient CSII management which is governed by a system-wide insulin pump policy. 50 adult patients with both type 1 and type 2 diabetes managed with insulin pumps admitted to the hospital for medical care were surveyed. Fisher's exact test was used to measure the association between categorical variables and satisfaction. Of those surveyed, 78% were satisfied with CSII management in the hospital. However, only 62% of participants answered favorably to the statement which evaluated Emergency Department (ED) staff communication regarding the current insulin pump policy. Therefore, targeted education to Emergency Department (ED) staff regarding the availability of an insulin pump protocol and nursing measures to limit CSII disconnection time may further improve patient satisfaction.

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Insulin Pump Therapy in the Perioperative Period: A Review of Care after Implementation of Institutional Guidelines

Cited by 19 publications

References 9 publications

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

Assessing Patient Satisfaction of ProvidersÃ¢ÂÂ Adherence to Inpatient Management with Continuous Subcutaneous Insulin Infusion (CSII) Policy: A Cross-Sectional Study

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Insulin Pump Therapy in the Perioperative Period: A Review of Care after Implementation of Institutional Guidelines

Cited by 19 publications

References 9 publications

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Short-Term Effects of Continuous Subcutaneous Insulin Infusion Therapy in Perioperative Patients with Diabetes Mellitus

Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy

Assessing Patient Satisfaction of ProvidersÃ¢ÂÂ Adherence to Inpatient Management with Continuous Subcutaneous Insulin Infusion (CSII) Policy: A Cross-Sectional Study

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Product

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About

Assessing Patient Satisfaction of ProvidersÃ¢ÂÂ Adherence to Inpatient Management with Continuous Subcutaneous Insulin Infusion (CSII) Policy: A Cross-Sectional Study