Enhanced Glycemic Recovery After Cardiac Surgery: A Quality Improvement Project

Persistent Link:
http://hdl.handle.net/10150/338757
Title:
Enhanced Glycemic Recovery After Cardiac Surgery: A Quality Improvement Project
Author:
Haro, Tyah Jo
Issue Date:
2014
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Hyperglycemia in adult cardiac surgery may result in post-operative sternal wound infections, pneumonia, renal failure, increased length of stay, and cost. The Surgical Care Improvement Project (SCIP) (2006) requires blood glucose control in cardiac surgery at 6:00 am on post-operative day one (POD1) and post-operative day two (POD2) to be 200mg/dL or less. Enhanced Recovery After Surgery (ERAS) guidelines use a Maltodextrin 12.5% carbohydrate beverage six hours and two hours pre-operative of general surgery to improve post-operative outcomes, cost, and length of stay. One study replicated ERAS guidelines in adult coronary artery bypass grafting surgery patients finding patients had decreased length of stay and improved glycemic control six hours postoperatively. The purpose of this quality improvement project is to outline a proactive approach to the modifiable risk factor of pre-operative fasting. This quality improvement project describes a pre-operative fasting carbohydrate protocol for non-emergent, adults, scheduled for cardiac surgery at 10:00am or later, with a hemoglobin A1C of 8.4% or less, and a body mass index of 35 or less. The protocol is named the Hungry Sweet Heart Protocol and an implementation plan is described for a community hospital located in Tucson, AZ. Updating practices of strict NPO status prior to cardiac surgery is a proactive measure to improve glycemic control and adherence to SCIP guidelines post-operatively. Interdisciplinary teams, including DNPs, are perfectly suited to guide this implementation.
Type:
text; Electronic Dissertation
Keywords:
ERAS; Glycemic Control; Hungry Sweet Heart Protocol; Hyperglycemia; PDSA; Cardiac Surgery; Nursing
Degree Name:
D.N.P.
Degree Level:
doctoral
Degree Program:
Graduate College; Nursing
Degree Grantor:
University of Arizona
Advisor:
Gallek, Matthew J.
Committee Chair:
Gallek, Matthew J.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.titleEnhanced Glycemic Recovery After Cardiac Surgery: A Quality Improvement Projecten_US
dc.creatorHaro, Tyah Joen_US
dc.contributor.authorHaro, Tyah Joen_US
dc.date.issued2014-
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractHyperglycemia in adult cardiac surgery may result in post-operative sternal wound infections, pneumonia, renal failure, increased length of stay, and cost. The Surgical Care Improvement Project (SCIP) (2006) requires blood glucose control in cardiac surgery at 6:00 am on post-operative day one (POD1) and post-operative day two (POD2) to be 200mg/dL or less. Enhanced Recovery After Surgery (ERAS) guidelines use a Maltodextrin 12.5% carbohydrate beverage six hours and two hours pre-operative of general surgery to improve post-operative outcomes, cost, and length of stay. One study replicated ERAS guidelines in adult coronary artery bypass grafting surgery patients finding patients had decreased length of stay and improved glycemic control six hours postoperatively. The purpose of this quality improvement project is to outline a proactive approach to the modifiable risk factor of pre-operative fasting. This quality improvement project describes a pre-operative fasting carbohydrate protocol for non-emergent, adults, scheduled for cardiac surgery at 10:00am or later, with a hemoglobin A1C of 8.4% or less, and a body mass index of 35 or less. The protocol is named the Hungry Sweet Heart Protocol and an implementation plan is described for a community hospital located in Tucson, AZ. Updating practices of strict NPO status prior to cardiac surgery is a proactive measure to improve glycemic control and adherence to SCIP guidelines post-operatively. Interdisciplinary teams, including DNPs, are perfectly suited to guide this implementation.en_US
dc.typetexten
dc.typeElectronic Dissertationen
dc.subjectERASen_US
dc.subjectGlycemic Controlen_US
dc.subjectHungry Sweet Heart Protocolen_US
dc.subjectHyperglycemiaen_US
dc.subjectPDSAen_US
dc.subjectCardiac Surgeryen_US
dc.subjectNursingen_US
thesis.degree.nameD.N.P.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNursingen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorGallek, Matthew J.en_US
dc.contributor.chairGallek, Matthew J.en_US
dc.contributor.committeememberGallek, Matthew J.en_US
dc.contributor.committeememberBuchner, Brianen_US
dc.contributor.committeememberPiotrowski, Kathleen A.en_US
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