Purpose: Comment the Discussion

To Comment

I currently work on the cardiovascular and monitored surgery unit at my hospital. Most of the surgeries we get are cardiovascular such as coronary artery bypass grafts (CABG). After CABGs, all patients whether diabetic or not diabetic, are placed on an insulin drip to maintain their blood glucose between a tight range.

Acute hyperglycemia is very common following cardiac surgery and can cause complications if the blood sugar is not controlled. These complications include sternal wound infections, hemodynamic instability, increased platelet aggregation, early morbidity, and mortality (Hargraves, 2014).

The article I have chosen discusses evidence-based practice change implementing insulin infusion protocols for glycemic control in cardiac surgeries. Prior to implementing the project for evidence based practice change some barriers were identified. The barriers were an outdated insulin infusion protocol targeting glycemic control and lack of knowledge about glycemic management among healthcare providers including physicians, advanced practice nurses, residents, and registered nurses (Hargraves, 2014).

To first implement the change, an insulin infusion protocol (IIP) needed to be revised. The outdated IIP initiated a low dose of insulin bolus when the blood glucose was 200 mg/dl or greater and without a maintenance doses which caused non-compliance which then caused incidences of hypoglycemia (Hargraves, 2014). The revised IIP is initiated when the patient's blood glucose reaches 150 mg/dl or greater then is followed by maintenance insulin doses based on the patient's blood sugar (Hargraves, 2014).
The second barrier of knowledge deficit among healthcare providers was corrected by giving healthcare providers a pretest and a posttest.

The healthcare providers were also given notice of mandatory education on the revised IIP for glycemic control (Hargraves, 2014). Results following the study concluded that after the mandatory education, healthcare providers scored higher on the posttest than the pretest and all demonstrated increased knowledge on glycemic management (Hargraves, 2014).

Before implementing the revised IIP, the average blood glucose was 122 mg/dl; after implementation the average blood glucose was 148 mg/dl thus decreasing the risk of hypoglycemic episodes that was more common with the outdated IIP (Hargraves, 2014). Although the sample following the practice change was smaller (28) than the sample prior (48), there was a significant difference between the incidence of hypoglycemia, 2 compared to 27 (Hargraves, 2014).

Science and technology are continually changing. This article gave great insight on evidence based practice change that is highly beneficial to the role of advanced practice nursing. As an advanced practice nurse, I want to be able to provide the best care to my patients. Through evidence based practice, I will be able to implement the needed changes to deliver quality care.

References

Hargraves, J. D. (2014, May 1). Glycemic control in cardiac surgery: Implementing an evidence-based insulin infusion protocol. American Journal of Critical Care, 23(3), 250-258.

Thing to Remember:

• Answer this discussion with opinions/ideas creatively and clearly. Supports post using several outside, peer-reviewed sources.

• 1 References, find resources that are 5 years or less

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