Farrell, Megan

Merkle, Travis

Mrzljak, Kathryn

English

eCommons at Roseman University

Baseline CharacteristicsPre-Protocol(N=141)Post-Protocol(N=54)Age, yr (SD) 68.6 (9.5) 68.7 (9.8)Female, n (%) 47 (33.3) 15 (27.8)CABG, n (%) 116 (82.3) 43 (79.6)Body Mass Index, (SD) 29.1 (6.1) 28.5 (6.6)Diabetic History, n (%) 63 (44.6) 27 (50)Preoperative HbA1c, % (SD) 6.6 (1.6) 6.7 (1.6)Efficacy of Pharmacy Managed Conversion of Intravenous to Subcutaneous Insulin in Cardiac Surgery PatientsMegan Farrell, PharmD; Travis Merkle, PharmD, BCCCP; Kathryn Mrzljak, PharmD, MBA, BCPSMethods• Data Collection Range: ○ Pre-protocol: November 1, 2021 – August 30, 2022○ Post-protocol: November 21, 2022 – March 30, 2023• Patient data was identified utilizing the electronic health record integrated surgical scheduler • Primary Outcome:○ Achievement of target glycemic goals (70-180 mg/dL) in the 48 hours after transition from intravenous to subcutaneous insulin• Secondary Outcomes:○ Hypoglycemic events (glucose <70 mg/dL), duration of intravenous insulin infusion, insulin glargine dosage, and incidence of atrial fibrillationPreliminary Results Discussion• Patient groups are relatively well matched at baseline, with the exception of more patients in the post-protocol group having diabetic history (44.6% vs 50%)• Primary Outcome:○ Amount of glucose readings within goal range (70-180 mg/dL)has improved by 3.9% in the post-protocol group vs pre-protocol group• Secondary Outcomes: ○ Reassuring regarding safety of protocol as there was a similar incidence of hypoglycemic events between groups○ Decrease in time on insulin drip + increase in insulin glargine dose show positive trend toward achievement of more efficient patient transitions and improved initial insulin coverageConclusion• Education: Ensuring that the entire team (pharmacist, physician, and nurse) are all aware of how to utilize protocol to optimize patient glycemic control• Further Research: Medication use evaluation to validate appropriate use of the pharmacist managed insulin transition protocol • Overall outcomes and possible protocol improvements pending final resultsReferences1. Galindo RJ, Fayfman M, Umpierrez GE. Perioperative Management of Hyperglycemia and Diabetes in Cardiac Surgery Patients. Endocrinol Metab Clin North Am. 2018;47(1):203-222. doi:10.1016/j.ecl.2017.10.0052. Elizabeth W. Duggan, Karen Carlson, Guillermo E. Umpierrez; Perioperative Hyperglycemia Management: An Update. Anesthesiology. 2017; 126:547–560 3. McAlister FA, Man J, Bistritz L, et al. Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes. Diabetes Care. 2003;26(5):1518–244. Lazar HL, McDonnell M, Chipkin SR, et al. The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg. 2009;87(2):663-669Background• Hyperglycemia (≥ 140 mg/dL) is reported to occur in 60-80% of patients undergoing cardiac surgery1○ Prevention of hyperglycemia in the perioperative period is correlated with improved outcomes2,3: • Recommendations from Society of Thoracic Surgeons - Guidelines for Blood Glucose Management During Adult Cardiac Surgery4:○ Maintain blood glucose > 180 mg/dL perioperatively○ Utilize IV insulin for at least 24-48h postoperatively → transition to subcutaneous insulin○ Ideally a standard institutional protocol is used to facilitate transitionObjective• Analyze efficacy and safety of pharmacy managed protocol for conversion of intravenous to subcutaneous insulin in adult cardiac surgery patientsInclusion Criteria:• ≥ 18 years of age• Open heart surgery (AVR, CABG, MVR, SMVR)• Received postoperative insulin infusionPrimary OutcomePre-Protocol(N=141)Post-Protocol(N=54)Glucose Readings in Goal – Diabetic, n (%) 423 (72.4) 196 (76.3)Glucose Readings in Goal – Nondiabetic, n (%) 558 (94.9) 195 (96.1)Secondary OutcomesPre-Protocol(N=141)Post-Protocol(N=54)Hypoglycemic Events,n (%) 4 (0.3) 2 (0.4)Time on Insulin Drip, h (SD) 38.1 (24.8) 33.3 (15.4)Insulin Glargine Dose, units (SD) 8.8 (10.3) 12.5 (10.6)Acute Kidney Injury, n (%) 73 (51.8) 27 (50)Atrial Fibrillation, n (%) 56 (39.7) 26 (48.1)↓Incidence of Wound Infection ↓ Incidence of Acute Kidney Injury↓ Hospital Length of Stay ↓ Mortality

Efficacy of Pharmacy Managed Conversion of Intravenous to Subcutaneous Insulin in Cardiac Surgery Patients

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Efficacy of Pharmacy Managed Conversion of Intravenous to Subcutaneous Insulin in Cardiac Surgery Patients

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