Comparison of Intraoperative Best Practice Advisory Reminders to Protocolize Insulin Administration Versus Standard Care in Patients at High Risk of Hyperglycemia
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 7,232
- 试验地点
- 2
- 主要终点
- Hyperglycemia (glucose >180 mmol/dL)
研究概览
简要总结
This study will assess the implementation of a glucose management clinical decision support tool. The specific objective is to determine if supplementing the existing glucose check reminder with a best practice advisory (BPA), an actionable insulin dosing calculator, providers will be influenced to improve the control of hyperglycemia.
详细描述
Poor intraoperative glucose control has been linked to multiple types of infections including surgical site infections and urinary tract infections. Several studies suggest maintaining glucose at less than 180 mg/dL effectively prevents infections, and minimizes risks of hypoglycemia as compared to stricter blood glucose targets.
The insulin dosing protocol that will be used in the study is available for use throughout the Vanderbilt University Medical Center (VUMC) Department of Anesthesiology. The insulin calculator (BPA) automates the protocol guidelines. When a patient meets the study criteria, the BPA will provide an automated notification through the electronic health record system. These automated notifications will pop up intraoperatively after the glucose check reminder in cases where the patient meets the study criteria. The provider is not forced to follow the recommendations of the insulin dosing calculator, rather it just serves as a reminder of best practices as defined by our department.
The specific objective is to determine if supplementing the existing glucose check reminder with a BPA, an actionable insulin dosing calculator, will influence providers to improve the control of hyperglycemia. Study results will guide the future integration of the BPA at VUMC.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •All patients having surgery at Vanderbilt University Medical Center Main Operating Rooms (ORs), Vanderbilt Medical Center Children's Hospital, Medical Center East or Gynecological (4S) ORs, who qualify for the glucose check best practice advisory (BPA). To qualify for the glucose BPA, the patient must meet the following criteria: 1) a documented diagnosis of diabetes, without a recorded measurement of glucose within the last 2 hours, or 2) the patient had an insulin administration within the last twelve hours and did not have a recorded measurement of blood glucose within the last hour.
排除标准
- •Patients having surgery at other locations
- •Patients not qualifying for the VUMC glucose check BPA
- •Provider participants:
- •Any provider of eligible patients may receive the BPA while providing care for these patients.
结局指标
主要结局
Hyperglycemia (glucose >180 mmol/dL)
时间窗: PACU admission to discharge (1-3 hours post operatively)
Frequency of hyperglycemia (glucose \>180 mg/dL) at first Post Anesthesia Care Unit (PACU) measurement.
次要结局
- Hypoglycemia (glucose <60 mmol/dL)(PACU admission to discharge (1-3 hours post operatively))
- Adherence to MPOG GLU-05(Intraoperative)
- Intraoperative glucose monitoring(Intraoperative)
- Intraoperative Insulin(Intraoperative)
- Glucose at first PACU measurement(PACU admission to discharge (1-3 hours post operatively))
- Adherence to Multicenter Perioperative Outcomes Group (MPOG) GLU-01(Intraoperative)
- Magnitude of intraoperative hyperglycemia(Intraoperative)
研究者
Miklos Kertai
Professor of Anesthesiology
Vanderbilt University Medical Center