Pharmacy Management of Postoperative Blood Glucose in Open Heart Surgery Patients: Evaluation of an Intravenous to Subcutaneous Insulin Protocol

Stahnke, Amanda M.; Struemph, Kelly; Behnen, Erin M.; Schimmelpfennig, Julia

doi:10.1310/hpj4902-164

Hosp Pharm

2014

DOI: 10.1310/hpj4902-164

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Pharmacy Management of Postoperative Blood Glucose in Open Heart Surgery Patients: Evaluation of an Intravenous to Subcutaneous Insulin Protocol

Amanda M. Stahnke

Kelly Struemph

Erin M. Behnen

et al.

Abstract: Though differences were not found in compliance with SCIP postoperative day 1 and 2 measures, fewer sternal wound infections and hypoglycemic episodes were reported, indicating that the pharmacy protocol may have a positive impact on patient outcomes.

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Cited by 3 publications

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Transitioning Safely from Intravenous to Subcutaneous Insulin

Kreider

Lien

2015

Curr Diab Rep

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The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease.

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Transitioning Safely from Intravenous to Subcutaneous Insulin

Kreider

Lien

2015

Curr Diab Rep

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Optimizing Postoperative Glucose Management in CABG Patients: Exploring Early Transition to Subcutaneous Insulin

Alzghoul,

Weimer,

Antigua

et al. 2024

JCDD

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Introduction: Tight glycemic control is essential for optimal outcomes after coronary artery bypass graft (CABG) surgery, regardless of pre-operative diabetes status. The ideal timing for transitioning from intravenous (IV) to subcutaneous (SC) insulin remains unclear. This study addresses this knowledge gap by comparing the effects of early transition (postoperative day 1, POD1) versus delayed transition on glycemic control and patient outcomes after CABG surgery. Methods: We analyzed data from a single tertiary medical center focusing on patients receiving insulin during their CABG hospitalization between 1 and 31 October 2022. We divided patients into two groups based on their transition timing: (1) Delayed Transition Group, patients transitioned from IV insulin infusion to SC insulin after POD1; and (2) Early Transition Group, patients transitioned on POD1. The primary outcome was the incidence of euglycemia on POD1. Secondary outcomes included rates of maintaining euglycemia from POD1 until POD10 or hospital discharge, hospital length of stay (LOS), ICU LOS, mean glucose levels, rates of hyperglycemia (blood glucose > 180 mg/dL) and hypoglycemia (blood glucose < 70 mg/dL), and rate of restarting IV insulin. Statistical analysis adjusted for BMI and diabetes diagnosis. Results: A total of 394 patients were enrolled, with 68 patients (17.3%) in the delayed-transition group and 326 patients (82.7%) in the early-transition group. Majority of the patients were males (74%), with an average age of 67 ± 9 years. Mean HbA1C and creatinine levels were comparable between the two groups. Patients in the early-transition group experienced a shorter ICU and hospital length of stay compared to the delayed-transition group, without a higher risk of restarting IV insulin. Conclusions: Early transition from IV insulin drip to SC insulin on POD1 of CABG surgery reduces ICU and hospital LOS without increasing the risk of transitioning back to IV insulin.

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Decision Support Tool to Improve Glucose Control Compliance After Cardiac Surgery

Fedosov

Dziadzko

Dearani

et al. 2016

AACN Advanced Critical Care

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Hyperglycemia control is associated with improved outcomes in patients undergoing cardiac surgery. The Surgical Care Improvement Project metric (SCIP-inf-4) was introduced as a performance measure in surgical patients and included hyperglycemia control. Compliance with the SCIP-inf-4 metric remains suboptimal. A novel real-time decision support tool (DST) with guaranteed feedback that is based on the existing electronic medical record system was developed at a tertiary academic center. Implementation of the DST increased the compliance rate with the SCIP-inf-4 from 87.3% to 96.5%. Changes in tested clinical outcomes were not observed with improved metric compliance. This new framework can serve as a backbone for development of quality control processes for other metrics. Further and, ideally, multicenter studies are required to test if implementation of electronic DSTs will translate into improved resource utilization and outcomes for patients.

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Pharmacy Management of Postoperative Blood Glucose in Open Heart Surgery Patients: Evaluation of an Intravenous to Subcutaneous Insulin Protocol

Abstract: Though differences were not found in compliance with SCIP postoperative day 1 and 2 measures, fewer sternal wound infections and hypoglycemic episodes were reported, indicating that the pharmacy protocol may have a positive impact on patient outcomes.

Cited by 3 publications

References 10 publications

Transitioning Safely from Intravenous to Subcutaneous Insulin

Transitioning Safely from Intravenous to Subcutaneous Insulin

Optimizing Postoperative Glucose Management in CABG Patients: Exploring Early Transition to Subcutaneous Insulin

Decision Support Tool to Improve Glucose Control Compliance After Cardiac Surgery

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