November 4, 2015
Pharmacist-Led Program Improves Glycemic Control for Surgical Patients

Portland, OR—A glycemic control program led by pharmacists improved outcomes for surgical patients who either had diabetes or developed stress-induced hyperglycemia as a result of surgery.

That’s according to a new study published recently in the American Journal of Pharmacy Benefits. Kaiser Permanente researchers compared patients who had surgery after the beginning of the glycemic control program to those who had surgery before the program initiation.

“Patients with diabetes and uncontrolled blood sugar are more likely to have complications after surgery, such as wound infections that can land them back in the hospital,” explained lead author David Mosen, PhD, a researcher at the Kaiser Permanente Center for Health Research in Portland.

The intervention began in 2009 with the glucose screening of every surgical patient at the Kaiser Permanente Sunnyside Medical Center in Portland and referral of those with high blood sugar to a pharmacy-led Glycemic Control Team.

Researchers compared 4,811 eligible patients in the first year of the intervention and 5,465 patients in the second year of the intervention to 1,277 patients in 2008, before the Glycemic Control Team was available.

Results indicate that, after the second year, intervention patients were more than two times as likely to have well-controlled blood sugar the day following surgery; 69% less likely to have hypoglycemia in the 3 days following surgery; 33% less likely to be readmitted to the hospital in the 3 months after discharge and 28% less likely to visit the ED in the 3 months after discharge. As a bonus, patients in the intervention group incurred $284 per month lower medical costs in the 6 months following discharge compared to the control group.

“We know that controlling blood sugar in these patients produces better clinical outcomes, but surgeons and anesthesia providers may not have the time or expertise to appropriately monitor and adjust insulin regimens after surgery,” co-author Karen Mularski, MD, a hospitalist, said in a Kaiser Permanente press release. “Establishing a pharmacy-led care team dedicated to addressing the specific needs of diabetes patients undergoing surgery was crucial to improving blood sugar and overall outcomes.”

Pharmacists worked as a team with surgeons, hospitalists, endocrinologists, diabetes educators, and nutritionists to develop a protocol that included recommendations on when to begin and end intravenous insulin, how to transition from intravenous to subcutaneous insulin, how to adjust insulin doses, and how to manage patients on tube feedings or intravenous nutrition.

As part of the intervention, the pharmacists met with each patient to obtain a history, explain the frequent blood sugar monitoring and discuss why they might be receiving insulin in the hospital even if they weren’t on insulin at home.

The pharmacy team also wrote and adjusted insulin orders, ordered relevant blood sugar and laboratory tests, requested consults with dieticians and diabetes educators, and made recommendations on postdischarge orders for insulin, oral medications, and diabetic supplies.
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