Perioperative Blood Glucose Control

Abstract

Progress in improving care processes for hospitalized patients with diabetes has been very slow. The prevalence of diabetes is increasing steadily, making it a diagnosis that is present more often in patients who are hospitalized to have surgery. Evidence demonstrating the benefits of blood sugar control in hospitalized patients has been accumulating, which has resulted in clinical practice recommendations that provide direction for changing practice. Multidisciplinary development of institution-specific standards for the care of patients with diabetes is essential for improvement in processes and outcomes. The safety implications of diabetes care practice changes require close monitoring and timely reporting. There are increased costs associated with diabetes care practices that are needed to improve blood glucose control in hospitalized patients, and these are offset, at least in part, by cost savings that occur because of improved outcomes. Perioperative nurses are integral to making practice changes that will improve outcomes for patients with diabetes. Their participation in multidisciplinary teams who are working toward improving outcomes for patients with diabetes will ensure that the unique needs of patients having surgery are represented and that plans include care processes that prevent complications related to the surgery itself as well as uncontrolled blood glucose levels. Perioperative nurses can collaborate with other health professionals in developing standards, including policies, procedures, and protocols, that are necessary for making changes in diabetes care practices. In addition, perioperative nurses are providing diabetes care by monitoring blood glucose levels, assuring timely treatments for elevated blood glucose levels, obtaining equipment needed for implementation of intravenous insulin protocols, documenting blood glucose levels and treatments for hyperglycemia, collecting data to evaluate care processes and outcomes, and providing feedback regarding effectiveness of diabetes care practices to individuals and groups who have responsibility for process improvement activities.