Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada
Center for Quality, Innovation and Safety, Western University, London, Ontario, Canada.
BMJ Open Qual. 2022 May;11(2). doi: 10.1136/bmjoq-2021-001796.
In-hospital glycaemic management can reduce post-transplant morbidity, but is not always part of transplant care.
We aimed to reduce the mean number of postoperative days in hyperglycaemia (≥2 blood glucose >12 mmol/L in 24 hours) in kidney and liver transplant recipients by 30%. We also aimed to reduce the mean number of days between transplant admission to endocrine consult by 2.0 days.
DESIGN, SETTING, PARTICIPANTS: We conducted a quality improvement project in liver and kidney transplant recipients admitted to an academic transplant unit in Canada between 1 March 2019 and 1 May 2021.
We developed a bedside algorithm to monitor post-transplant capillary blood glucose; the algorithm also included thresholds for nursing-initiated inpatient endocrinology consultation.
We examined outcome (postoperative days in hyperglycaemia, days to inpatient endocrine consultation), process (nursing documentation of postoperative blood sugars) and balancing measures (nursing workload, postoperative days in hypoglycaemia) following implementation of our algorithm. We used Plan-Do-See-Act cycles to study three iterations of our algorithm, and used box plots to present outcomes before and after algorithm implementation.
In the pre-intervention period, 21 transplant recipients spent a mean of 4.1 (SD 2.4) postoperative days in hyperglycaemia before endocrine consultation. The mean number of days between hospital admission to endocrine consult was 10.7 (SD 13.0) days.In the post-intervention period, we observed a 62% reduction in postoperative days in hyperglycaemia. The mean number of days between admission and endocrine consult was reduced by 6.3 days (59% reduction).
Implementation of a simple, bedside algorithm for postoperative glucose monitoring and detection of hyperglycaemia in transplant patients, reduced the mean number of postoperative days in hyperglycaemia and time to inpatient endocrine consultation. Our algorithm continues to be used in our academic transplant unit.
住院期间的血糖管理可以降低移植后的发病率，但并非总是移植护理的一部分。
我们旨在将肾和肝移植受者的高血糖术后天数（24 小时内 2 次血糖>12mmol/L）减少 30%。我们还旨在将移植入院至内分泌咨询的天数减少 2.0 天。
设计、设置、参与者：我们在加拿大一家学术移植中心的肝和肾移植受者中进行了一项质量改进项目，时间为 2019 年 3 月 1 日至 2021 年 5 月 1 日。
我们开发了一种床边算法来监测移植后毛细血管血糖；该算法还包括护士启动住院内分泌会诊的阈值。
我们检查了实施我们的算法后的结果（高血糖术后天数、内分泌会诊入院天数）、过程（术后血糖的护理记录）和平衡措施（护理工作量、低血糖术后天数）。我们使用计划-执行-检查-行动循环来研究我们的算法的三个迭代，并使用箱线图展示算法实施前后的结果。
在干预前期间，21 名移植受者在接受内分泌咨询前平均有 4.1（SD 2.4）天的高血糖术后天数。从入院到内分泌会诊的平均天数为 10.7（SD 13.0）天。在干预后期间，我们观察到高血糖术后天数减少了 62%。从入院到内分泌会诊的平均天数减少了 6.3 天（减少了 59%）。
实施一种简单的床边算法来监测术后血糖和检测移植患者的高血糖症，可减少高血糖术后天数和住院内分泌会诊时间。我们的算法继续在我们的学术移植中心使用。
