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Insulin Infusion for Elevated Blood Glucose Levels Post Cardiac Surgery – Adult ‐ Inpatient [45]

Insulin Infusion for Elevated Blood Glucose Levels Post Cardiac Surgery – Adult ‐ Inpatient [45] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols



Delegation Protocol Number: 45

Delegation Protocol Title:
Insulin Infusion for Elevated Blood Glucose Levels Post Cardiac Surgery - Adult - Inpatient

Delegation Protocol Applies To:
UWHC Adult Inpatients on Cardio-Thoracic Surgery & Transplant Unit (B4/5)

Target Patient Population:
Postop cardiac surgery, ventricular assist device and heart transplant patients within 24 hours of
the anesthesia end time.

Delegation Protocol Champion:
Shahab Akhter, MD – Department of Surgery; Cardiothoracic

Delegation Protocol Reviewers:
Margaret Murray, CNS –Nursing, Cardiac Surgery
Gwen Klinkner, CNS – Nursing, Diabetes
Melissa Meredith, MD- Department of Medicine; Endocrinology
Megan Barry, PA- Diabetes Management Service

Responsible Party:
Department of Surgery- Cardiothoracic

Purpose Statement:
The ordering of a DMS (Diabetes Management Service) consult, insulin drip and associated
orders in the insulin drip order set is delegated from the cardiac or critical care provider to
Registered Nurses (RNs). This will give nursing staff the ability to continue the insulin drip at
arrival to the ICU to control blood glucose early postoperatively and initiate an insulin drip and
order a Diabetes Management Service (DMS) consult for postoperative patients with one
elevated blood glucose result within 24 hours of anesthesia end time. This will improve
compliance with a SCIP (Surgical Care Improvement Project) measure and promote proper
wound healing.

Who May Carry Out This Delegation Protocol:
Any inpatient registered nurse caring for a patient within the defined patient population and
who is trained in the use of this protocol.

Guidelines for Implementation:
1. In order to initiate this protocol, the order “Initiate B4/5 Insulin Infusion Protocol”
within the Cardiac Surgery Postoperative order sets will be selected and signed by a
provider.
2. The following conditions should prompt the nurse to enact the protocol:
2.1. If the patient has a single blood glucose, serum or POC (point of care) result
greater than 180 milligrams/deciliter, or
2.2. the patient has an insulin drip infusing upon arrival to the ICU that was initiated
in the OR.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org


3. If either condition is met, the nurse will complete these steps:
3.1. The nurse will validate the following order is pre-checked: “Cardiovascular
Surgery Insulin Infusion Protocol has been initiated" in the Cardiac Surgery
Postoperative order sets.
3.2. The nurse will open the “IP - Insulin Infusion - Adult - Supplemental” order set
and select the DMS consult order if not previously ordered.

Order Mode: Cosign Required Protocol/Policy

References:
1. The Joint Commission. (2014 Jan). Specifications Manual for National Hospital
Inpatient Quality Measures Discharges 01-01-14 (1Q14) through 09-30-14 (3Q14).
4.3:1-188-190.
2. McDonnell, M. E., Alexanian, S. M., Junqueira, A., Cabral, H., & Lazar, H. L. (2013).
Relevance of the Surgical Care Improvement Project on glycemic control in patients
undergoing cardiac surgery who receive continuous insulin infusions. The Journal of
thoracic and cardiovascular surgery, 145(2), 590–4; discussion 595–7.
doi:10.1016/j.jtcvs.2012.09.031
3. McDonnell, M. E., Alexanian, S. M., White, L., & Lazar, H. L. (2012). A primer for
achieving glycemic control in the cardiac surgical patient. Journal of cardiac surgery,
27(4), 470–7. doi:10.1111/j.1540-8191.2012.01471.x
4. Saager, L., Collins, G.L., Burnside, B., Tymkew, H., Zhang, L., Jacobsohn, E. & Avidan,
M. (2008 Jun). A randomized study in diabetic patients undergoing cardiac surgery
comparing computer-guided glucose management with a standard sliding scale
protocol. Journal of Cardiothoracic Vascular Anesthesia. 22(3):377-82.
5. Blaha J, Kopecky P, Matias M, Hovorka R, Kunstyr J, Kotulak T, Lips M, Rubes D,
Stritesky M, Lindner J, Semrad M, Haluzik M. (2009, May). Comparison of three
protocols for tight glycemic control in cardiac surgery patients. Diabetes Care.
32(5):757-61.
6. Furnary AP, Wu Y, Bookin SO. (2004, Mar-Apr). Effect of hyperglycemia and
continuous intravenous insulin infusions on outcomes of cardiac surgical
procedures: the Portland Diabetic Project. Endocrine Practice. 10 Suppl 2:21-33.
7. Hovorka R, Kremen J, Blaha J, Matias M, Anderlova K, Bosanska L, Roubicek T,
Wilinska ME, Chassin LJ, Svacina S, Haluzik M. (2007, Aug). Blood glucose control by
a model predictive control algorithm with variable sampling rate versus a routine
glucose management protocol in cardiac surgery patients: a randomized controlled
trial. Journal Clinical Endocrinology Metabolism. 92(8):2960-4.

Collateral Documents/Tools:
Standards of Medical Care in Diabetes- 2013 Clinical Practice Guideline (CPG)
IP – Cardiac Transplant – Adult – Postoperative [2849] Order Set
IP – Ventricular Assist Device – Adult – Postoperative [3194] Order Set
IP- Cardiac Surgery – Adult – Postoperative [2821] Order Set

Approved By:
UWHC Nursing Practice Council – December 2013 (expedited process), June 2015 (expedited
process); June 2015 (expedited process)
UWHC P&T Committee – December 2013 (expedited process); July 2015 (expedited process)
UWHC Medical Board – December 2013 (expedited process); July 2015 (expedited process)
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org



Effective Date: July 2015

Scheduled for Review: July 2017

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org