An excessive amount of sugar in a person’s bloodstream, or hyperglycemia, occurs most often in people with diabetes. When someone experiencing hyperglycemia has surgery, the chances of infection and other risks are also increased. However, a recent study by a team of University of Iowa Health Care specialists from eight different departments found that insulin treatments and more stringent glycemic level checks can reduce the rate of a surgical site infection (SSI) during colon surgery by 40%. Since implementation, there have have been no reported instances of hyperglycemia at all.
Two members of the Division of Endocrinology were on the team that developed this new quality and safety procedure. Sarah Nolan, physician assistant, and Melissa Collier, RN, nurse practitioner, assisted with developing the protocol by developing a control blood sugar and identifying the target levels. Based off existing CDC and ADA guidelines as well as recommendations from colleagues within the division, Collier and Nolan constructed a framework for the protocol. The protocol required providers to check a surgery candidate’s blood glucose levels before and after surgery to monitor levels and to supply insulin as needed. An iterative process, after initial tests, the team adjusted the plans accordingly.
“There’s been decades of ongoing research, and it’s constantly evolving. There’s a lot of back and forth between very tight controls and not enough controls, so we’re trying to find that middle ground,” Nolan said.
Researchers from the departments of colorectal surgery, anesthesia, obstetrics and gynecology, pharmacy, nursing, endocrinology, cardiothoracic surgery, and the Quality Improvement Program collaborated on this study. Read more about this successful interdisciplinary quality improvement project.