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

Abstract

To develop and implement a protocol to improve blood glucose (BG) control during transition from intravenous (IV) to subcutaneous (SC) insulin, increase compliance with Surgical Care Improvement Project (SCIP) measures, and decrease sternal wound infections post open heart surgery (OHS). An IV to SC protocol was developed and implemented. A retrospective chart review of patients who underwent OHS was conducted from January 2, 2009 to September 30, 2010 (pre protocol) and from October 1, 2010 to December 31, 2011 (post protocol). Data collected included age, sex, history of diabetes mellitus (DM), BG values, hypoglycemia incidence, length of stay, and incidence of sternal wound infections. A total of 243 patients were included in the study. Compliance with SCIP postoperative day 1 and 2 BG goals was similar pre and post protocol (P = .24 and .248). One sternal wound infection occurred after protocol implementation, whereas 6 occurred pre protocol (P = .046). Change in BG when transitioning from IV to SC insulin was similar between the groups, however there were significantly fewer hypoglycemia episodes post protocol (P < .001). 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.