title: Update on a Quality Initiative to Standardize Perioperative Care for Continuous Subcutaneous Insulin Infusion Therapy.
abstract: OBJECTIVE
  The objective of the analysis was to review the effectiveness of a care process model (CPM) developed to guide management of patients on insulin pump therapy undergoing elective surgical procedures.
  
  
  METHODS
  Electronic medical records were reviewed to assess the impact of the CPM on documentation of insulin pump status, glucose monitoring, and safety during the perioperative phase of care. Post-CPM care was compared with management provided before CPM implementation.
  
  
  RESULTS
  We reviewed 45 cases on insulin pump therapy in the pre-CPM cohort and 106 in the post-CPM cohort. Demographic characteristics, categories of surgery, and perioperative times were not significantly different between the 2 groups. Recommended hemoglobin A1c monitoring occurred in 73% of cases in the pre-CPM cohort but improved to 94% in the post-CPM group (P < .01). There was a higher frequency of documentation of the insulin pump during the preoperative, intraoperative, and postanesthesia care unit segments of care in the post- vs pre-CPM periods (all P < .01). The number of cases with intraoperative glucose monitoring increased (57% pre-CPM vs 81% post-CPM; P < .01). Glycemic control was comparable between the 2 CPM periods. Hypoglycemia was rare, with only 3 episodes in the pre-CPM group and 4 in the post-CPM. No adverse events associated with perioperative insulin pump use were observed.
  
  
  CONCLUSIONS
  This analysis adds to previous data on use of insulin pump therapy during the perioperative period. Some processes require additional attention, but data continue to indicate that a standardized approach to care can lead to a successful and safe transition of insulin pump therapy throughout the perioperative period.
authors.affiliation: Division of Endocrinology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Mackey
authors.affiliation: Division of Endocrinology, Mayo Clinic, Scottsdale, AZ, USA thompson.bithika@mayo.edu.
authors.forename: Bithika M
authors.initials: BM
authors.lastname: Thompson
authors.affiliation: Division of Endocrinology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Boyle
authors.affiliation: Division of General Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA.
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Apsey
authors.affiliation: Division of Endocrinology, UC Davis Medical Center, Sacramento, CA, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Seifert
authors.affiliation: Division of General Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Schlinkert
authors.affiliation: Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, AZ, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stearns
authors.affiliation: Division of Endocrinology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D017558:Elective Surgical Procedures; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D055104:Infusions, Subcutaneous; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems / Q000009:adverse effects / Q000592:standards*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000592:standards; D061214:Patient Safety / Q000592:standards; D019990:Perioperative Care / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: CSII; diabetes mellitus; insulin pump; perioperative; surgery