Developing a Clinical Practice Guideline for Surgical Diabetic Patients

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and a lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients have been shown to improve quality care, decrease complications, increase the efficiency, and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which are recognized risk factors for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the northeast United States. The purpose of this project was to develop a clinical practice guideline for elective surgery patients in this hospital outlining the acceptable HgbA1C level for surgical clearance. The five attributes of change, individual and collective leadership, operational support, fostering relationships, organizational learning, and balance, framed the development of this project. Based on the current evidence, the HgbA1C level approved to be acceptable for surgery clearance was 8.5% mg/dL. An 18-member expert panel consisting of anesthesiologists, nurse anesthetists, an endocrinologist, a diabetic nurse educator, an administrator, physician assistants, nurse practitioners, and surgeons reviewed the proposed guideline using the AGREE II tool. Using a scale of 1 to 7 (strongly disagree to strongly agree), the team members agreed with the proposed guideline, with a score of 6 or higher in each domain. Utilization of this guideline may promote positive social change by addressing the gap in practice at this hospital and significantly reducing the number of surgery cancellations among diabetic patients.