Improving insulin administration timing and patient blood glucose management on a Montana medical surgical patient care unit: a quality improvement project

Abstract

Background: Effective blood glucose management and prevention of hyperglycemia (BG >180mg/dL) and hypoglycemia (BG <70mg/dL) are critical for inpatient surgical care. A single instance of hyperglycemia can lead to poorer surgical outcomes, increased morbidity and mortality, and heightened infection risk in surgical populations, particularly those undergoing primary joint arthroplasty or abdominal surgery. Local Problem: At the selected project site, insulin administration times vary, ranging from just a few minutes to over 90 minutes after the collection of capillary blood glucose (CBG). Patients receiving insulin more than 30 minutes after CBG collection are not receiving optimal treatment, which necessitates further capillary BG testing or insulin dosing adjustments. Methods: The DNP student and Information Technology (IT) team developed a chart review and data collection tool to assess bi-monthly whether insulin administration time from CBG collection improved in one medical/surgical care unit. The proportion of CBGs collected by RNs was evaluated using a voluntary reporting system by staff. Pre-implementation included a week of staff education on insulin administration, pharmacodynamics, best practices, and workflow alterations. Data analysis determined whether education and adjustments to the workflow could improve insulin administration proportions within 30 minutes of capillary blood glucose collection. Results: The proportion of insulin administrations within 30 minutes of CBG increased from 59% pre- intervention to 76% within two weeks, remaining statistically significant over the six- week period. The average interval from CBG collection decreased from 29.5 min to 23.8 min, marking a statistically significant reduction. RN CBG collection rates achieved the project goals within the first two weeks and maintained this throughout implementation, with over 50% of administrations completed by RNs. Conclusions: Achieving meaningful compliance with national insulin administration standards is feasible through a two- fold approach to quality improvement: intentional workflow alterations and effective, holistic education for RN and CNA staff members, enabling RNs to quickly administer insulin following CBG collection.