Strategic Planning

Strategic Planning of
Implementing Continuous Glucose Monitoring in the
Surgical Patient Population

Aim of the Project
The aim of this project is to achieve the standardized practice of implementing a continuous glucose monitoring device on all diabetics experiencing surgery at Hoag Hospital. The ultimate goal being a reduction in the risks and complications secondary to hyperglycemia which currently prolong hospital stays.
Outline of the Project
Upon admission to the Post Anesthesia Care Unit, all known and suspected diabetics, (i.e. those with abnormally elevated glucose levels in their presurgical blood work) will have their glucose levels monitored with the traditional finger stick method, noting pre and post operative level disparities to clearly define the problem. An MD order will need to be obtained to perform any accuchecks not already ordered.
A data collection sheet will be created to log the results of pre and post operative glucose levels, as well as any done intraoperatively. On each of these patients the times of the glucose level checks, along with the dosage and time of any insulin will be noted in the survey. In addition, the ordered frequency of postoperative glucose monitoring will also be recorded. Surgical start and finish times will be documented. This study will commence over a 10 day period, with at least 25 patients monitored, or until 25 patients are studied. Upon the conclusion of this collection of data, pre and post operative sugars will be correlated to the length and type of surgery.
Simultaneous to the above mentioned data collection; external research will be conducted on the potential choices of continuous monitoring devices. A thorough investigation of products available via the internet and the EBSCO library at Vanguard, in addition to recommendations or endorsements by the American Diabetic Association or the American Association of Clinical Endocrinologists will be conducted. Letters and personal interviews with vendors of the various companies selling these products will also take place. The vendor interviews will include a discussion of the application and usage of their product, in addition to the projected expense and feasibility of implementation to the clients and /or hospital. If possible, samples of product options will be procured from the vendors as well.
The culmination of the above external and internal research will first be presented to the perioperative staff of anesthesiologists and nurses, along with the perioperative nurse educators and managers in an informal presentation. A vendor of the most favored product will hopefully be a part of the presentation. If possible, any samples of products will be shared. The pros and cons of the different devices will be demonstrated. In addition to the presentation of the various devices, the evidence procured by the results of the patient glucose monitoring study will be displayed. If indeed the random data collection concludes there is a marked elevation of glucose relative to the surgical type and length, the need for intraoperative monitoring will be particularly stressed.
A power point presentation of all of the above mentioned efforts will be presented to the nursing informatics class.