Reducing hyperglycaemia post-kidney and liver transplant: a quality improvement initiative.

Autor:	Clemens KK; Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada kristin.clemens@sjhc.london.on.ca.; Center for Quality, Innovation and Safety, Western University, London, Ontario, Canada., Brahmania M; Center for Quality, Innovation and Safety, Western University, London, Ontario, Canada.; Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada.; London Health Sciences Centre, London, Ontario, Canada., Weernink C; London Health Sciences Centre, London, Ontario, Canada., Lofty K; Center for Quality, Innovation and Safety, Western University, London, Ontario, Canada.; London Health Sciences Centre, London, Ontario, Canada.; Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada., Rjoob H; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada., Berberich A; Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada., Gob A; Center for Quality, Innovation and Safety, Western University, London, Ontario, Canada.; Department of Medicine, Division of Hematology, Western University, London, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2022 May; Vol. 11 (2).
DOI:	10.1136/bmjoq-2021-001796
Abstrakt:	Background: In-hospital glycaemic management can reduce post-transplant morbidity, but is not always part of transplant care. Objective: We aimed to reduce the mean number of postoperative days in hyperglycaemia (≥2 blood glucose >12 mmol/L in 24 hours) in kidney and liver transplant recipients by 30%. We also aimed to reduce the mean number of days between transplant admission to endocrine consult by 2.0 days. Design, Setting, Participants: We conducted a quality improvement project in liver and kidney transplant recipients admitted to an academic transplant unit in Canada between 1 March 2019 and 1 May 2021. Intervention: We developed a bedside algorithm to monitor post-transplant capillary blood glucose; the algorithm also included thresholds for nursing-initiated inpatient endocrinology consultation. Main Outcome and Measures: We examined outcome (postoperative days in hyperglycaemia, days to inpatient endocrine consultation), process (nursing documentation of postoperative blood sugars) and balancing measures (nursing workload, postoperative days in hypoglycaemia) following implementation of our algorithm. We used Plan-Do-See-Act cycles to study three iterations of our algorithm, and used box plots to present outcomes before and after algorithm implementation. Results: In the pre-intervention period, 21 transplant recipients spent a mean of 4.1 (SD 2.4) postoperative days in hyperglycaemia before endocrine consultation. The mean number of days between hospital admission to endocrine consult was 10.7 (SD 13.0) days.In the post-intervention period, we observed a 62% reduction in postoperative days in hyperglycaemia. The mean number of days between admission and endocrine consult was reduced by 6.3 days (59% reduction). Conclusions: Implementation of a simple, bedside algorithm for postoperative glucose monitoring and detection of hyperglycaemia in transplant patients, reduced the mean number of postoperative days in hyperglycaemia and time to inpatient endocrine consultation. Our algorithm continues to be used in our academic transplant unit. Competing Interests: Competing interests: Unrelated to this work, KKC has attended conferences sponsored by Merck. She has received honoraria for providing Certified Medical Education talks from Sutherland Global Services Canada, the Canadian Medical and Surgical Knowledge Translation Research Group and the CPD Network. There are no other conflicts to disclose. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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