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Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward
AIMS: Variable rate intravenous insulin infusion (VRIII) is used perioperatively to maintain normoglycaemia in patients with diabetes who are undergoing surgery. The aims of this project were as follows: (1) to audit the extent to which perioperative prescribing of VRIII for diabetic vascular surger...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9950905/ https://www.ncbi.nlm.nih.gov/pubmed/36813469 http://dx.doi.org/10.1136/bmjoq-2022-002048 |
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author | Aimar, Kelsey Orozov, Nikola Spencer-Jones, Keely Burhan, Hafsa Butler, Nicola Kassim, Saifuddin Forsyth, James |
author_facet | Aimar, Kelsey Orozov, Nikola Spencer-Jones, Keely Burhan, Hafsa Butler, Nicola Kassim, Saifuddin Forsyth, James |
author_sort | Aimar, Kelsey |
collection | PubMed |
description | AIMS: Variable rate intravenous insulin infusion (VRIII) is used perioperatively to maintain normoglycaemia in patients with diabetes who are undergoing surgery. The aims of this project were as follows: (1) to audit the extent to which perioperative prescribing of VRIII for diabetic vascular surgery inpatients at our hospital meets established standards and (2) to use the results of the audit to guide improvement in the quality and safety of prescribing practices and reduce VRIII overuse. METHODS: Vascular surgery inpatients who had perioperative VRIII were included in the audit. Baseline data were collected consecutively from September to November 2021. There were three main interventions: a VRIII Prescribing Checklist, education of junior doctors and ward staff, and electronic prescribing system updates. Postintervention and reaudit data were collected consecutively from March to June 2022. RESULTS: The number of VRIII prescriptions totalled 27 in preintervention, 18 in postintervention and 26 in reaudit periods. Prescribers used the ‘refer to paper chart’ safety check more frequently postintervention (67%) and on reaudit (77%) compared with preintervention (33%) (p=0.046). Rescue medication was prescribed in 50% of postintervention and 65% of reaudit cases compared with 0% preintervention (p<0.001). Intermediate/long-acting insulin was appropriately amended more often in the postintervention versus preintervention period (75% vs 45%, p=0.041). Overall, VRIII was appropriate for the situation in 85% of cases. CONCLUSIONS: The quality of perioperative VRIII prescribing practices improved following the proposed interventions, with prescribers more frequently using recommended safety measures such as ‘refer to paper chart’ and rescue medication. There was a marked sustained improvement in prescriber-initiated adjustment of oral diabetes medications and insulins. VRIII is occasionally administered unnecessarily in a subset of patients with type 2 diabetes and may be an area for further study. |
format | Online Article Text |
id | pubmed-9950905 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-99509052023-02-25 Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward Aimar, Kelsey Orozov, Nikola Spencer-Jones, Keely Burhan, Hafsa Butler, Nicola Kassim, Saifuddin Forsyth, James BMJ Open Qual Quality Improvement Report AIMS: Variable rate intravenous insulin infusion (VRIII) is used perioperatively to maintain normoglycaemia in patients with diabetes who are undergoing surgery. The aims of this project were as follows: (1) to audit the extent to which perioperative prescribing of VRIII for diabetic vascular surgery inpatients at our hospital meets established standards and (2) to use the results of the audit to guide improvement in the quality and safety of prescribing practices and reduce VRIII overuse. METHODS: Vascular surgery inpatients who had perioperative VRIII were included in the audit. Baseline data were collected consecutively from September to November 2021. There were three main interventions: a VRIII Prescribing Checklist, education of junior doctors and ward staff, and electronic prescribing system updates. Postintervention and reaudit data were collected consecutively from March to June 2022. RESULTS: The number of VRIII prescriptions totalled 27 in preintervention, 18 in postintervention and 26 in reaudit periods. Prescribers used the ‘refer to paper chart’ safety check more frequently postintervention (67%) and on reaudit (77%) compared with preintervention (33%) (p=0.046). Rescue medication was prescribed in 50% of postintervention and 65% of reaudit cases compared with 0% preintervention (p<0.001). Intermediate/long-acting insulin was appropriately amended more often in the postintervention versus preintervention period (75% vs 45%, p=0.041). Overall, VRIII was appropriate for the situation in 85% of cases. CONCLUSIONS: The quality of perioperative VRIII prescribing practices improved following the proposed interventions, with prescribers more frequently using recommended safety measures such as ‘refer to paper chart’ and rescue medication. There was a marked sustained improvement in prescriber-initiated adjustment of oral diabetes medications and insulins. VRIII is occasionally administered unnecessarily in a subset of patients with type 2 diabetes and may be an area for further study. BMJ Publishing Group 2023-02-22 /pmc/articles/PMC9950905/ /pubmed/36813469 http://dx.doi.org/10.1136/bmjoq-2022-002048 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Quality Improvement Report Aimar, Kelsey Orozov, Nikola Spencer-Jones, Keely Burhan, Hafsa Butler, Nicola Kassim, Saifuddin Forsyth, James Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward |
title | Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward |
title_full | Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward |
title_fullStr | Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward |
title_full_unstemmed | Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward |
title_short | Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward |
title_sort | perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward |
topic | Quality Improvement Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9950905/ https://www.ncbi.nlm.nih.gov/pubmed/36813469 http://dx.doi.org/10.1136/bmjoq-2022-002048 |
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