Statement of the Problem

One in five patients over the age of 60 is a diabetic (Gavi & Hensley 2009). One in five of all patients admitted for surgery are undiagnosed diabetics (Mathias 2007). In view of these statistics, the patient population requiring glucose monitoring during surgical admissions will predictably increase. The current practice of multiple finger sticks for glucose samples throughout the perioperative experience is uncomfortable for the patient, an additional task for already busy nurses, and logistically challenging intraoperatively. A continuous glucose monitoring device placed on the patient preoperatively could alleviate patient discomfort, avoid delays of treatment, and avert many postoperative complications secondary to hyperglycemia.

Review of the Literature
Research suggests that because of the acute hyperglycemia which occurs intraoperatively, in known or suspected diabetics, glucose levels should be monitored every 1 to 2 hrs throughout the surgery (Maser, Ellers & Decherney 1996). However with the patient’s hands relatively inaccessible while covered under sterile drapes, glucose testing tends to be delayed until the patient reaches Phase I recovery, resulting in “chasing” elevated blood sugars with insulin injections (Allen 2008).
For the diabetic patient undergoing surgery, this acute hyperglycemic reaction puts him at risk for many complications. Intraoperatively, cardiovascular or neurological complications may occur (Maser, Ellers & Decherney 1996). Postoperative sustained blood glucose levels above 250 mg dL result in prolonged hospital stays due to delayed wound healing, and infections (Maser, Ellers & Decherney). The American Diabetic Association recommended in 2009 that glucose levels of critically ill patients be maintained between 140 and 180 mg dL(). In another study the recommended blood sugar intraoperatively was between 180 and 200 mg dL (Mathias 2007) . Therefore stringent monitoring of glucose levels throughout the perioperative process of diabetic patients is imperative to averting undesirable medical or surgical outcomes.
A continuous glucose monitoring device could prevent undetected detrimental glucose swings while lessoning the work load of the nursing staff. Currently there are 7 FDA approved devices on the market which are usually combined with an insulin pump (George 2009). Continuous glucose monitoring is now being utilized in some facilities during hospitalized labor and delivery on diabetic mothers (Stenninger & Lindqvist 2008). Subcutaneous glucose monitoring “Involves placing a glucose oxidase-based electrochemical sensor beneath the skin once every 3 to 7 days. The sensor measures interstitial glucose levels at regular intervals and transmits them wirelessly to a receiver where they are stored” (George 2009).

Aim of the Project
The aim of this project is to decrease the frequency of intermittent finger sticking for glucose results, while achieving continuous glucose monitoring throughout the hospital stay. The desired outcome being glucose levels of diabetics are maintained within the ADA recommended range of 140 to 160 mg dL as deviations will be promptly recognized and treated. The risks and complications secondary to hyperglycemia will be averted, and hospital stays will be shortened.
Outline of the Project
The first step will be to monitor glucose levels on patients who admit to the PACU, noting pre and post operative level disparities to clearly define the problem. Length of surgery will also be noted in addition to insulin requirements. This will be done over a 10 day period. As results are accumulating, external research will be conducted on the potential choices of continuous monitoring devices, the expense and feasibility of implementation. Ongoing internal assessments through casual interviews with anesthesiologists and perioperative coworkers will be performed throughout the process. Samples of product options will be procured and through the help of vendors, a trial run may be implemented if approval can be obtained from the unit managers and anesthesiologists. Results of these efforts will be presented to the perioperative staff and the nursing informatics class.







Reference list
Gavi, Shai, MD & Hensley, Jennifer, MD (2009). Diagnosis and management of type 2 diabetes in adults: A review of the ICSI guideline. Geriatrics , 64(6)
Mathias, J. (2007). Aiming for tighter glucose control... this article originally appeared in the September 2006 OR Manager. OR Manager, 10-12.
Maser, R., Ellers, J., & DeCherney, G. (1996). Glucose monitoring of patients with diabetes mellitus receiving general anesthesia: a study of the practices of anesthesia providers in a large community hospital. AANA Journal, 64(4), 357-361. Retrieved from CINAHL with Full Text database.
Allen, G. (2008). Evidence for practice. Continuous glucose monitoring during surgery. AORN Journal, 87(5) 1016 -1017