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theses

Purpose of Project: After review of the glycemic control of patients undergoing targeted temperature management (TTM) after cardiac arrest at a New Jersey hospital, data revealed that patients remained in a hyperglycemic state (Glucose >180 mg/dL) for more than 24 hours post initiation of TTM. The purpose of this quality improvement project was to improve upon the glycemic control of TTM patients through the use of an educational module emphasizing the importance and rationale behind glycemic management.

Methodology: Education was provided to the nursing staff who was responsible for the care of these TTM patients regarding the rationale behind glycemic control and current guidelines. Participants took part in a mandatory online education module made available via the hospitals online learning management system. Participants were required to review the online module and answer 10 questions reviewing the material at the end of the presentation. To successfully complete the module, all questions had to be answered correctly with a score of 100 percent. Data was collected through retrospective and prospective chart reviews of TTM patients prior to and after the education module was provided to the critical care and ED staff nurses. Data collected included age, gender, average glucose between zero and 24 hours, and confounding variables including medications mixed in dextrose, corticosteroids use, pressor use and previous diabetes diagnosis.

Results: An unpaired t- test was run comparing the mean glycemic values at 12 hours and 24 hours. Using an alpha value of 0.05 it was determined that there was no statistical significance between average glycemic values of TTM patients at 12 hours before education (M: 210.67 mg/dL, SD: 72) and after education (M: 202 mg/dL, SD: 72); (t= 0.263, P=0.79). It was also determined that at 24 hours, there was no statistical difference between the pre education group of TTM patients (M: 191.96 mg/dL, SD: 75.19) and the post education group of TTM patients (M: 208.5 mg/dL, SD: 70.5); (t= 0.603, P: 0.55) and in fact the mean at 24 hours increased after education Using SPSS, a Pearson product- moment correlation was run to determine if any relationship existed between the mean glucose values of the TTM patients and the use of intravenous insulin (r=-.314, n=37, p=.058), the use of corticosteroids (r=-469, n= 37, P= .003), the use of vasopressors (r=-.062, n= 37, P=0.714), the number of vasopressors (r=-.058, n= 37, P=0.732), use of continuous dextrose infusions (r=-.124, n=37, P= 0.465) and previous diagnosis of diabetes (r=-.616, n=37, P= <0.001).

Implications for Practice: Quality improvement is trying to constantly improve upon the way we care for patients, the constant need to provide the best, evidence based care. This project was an attempt at improving the care of this patient population. Based on the results, we can do better. This project may have been the first step in improving the glycemic control of TTM patients using the Plan, Do Study Act framework. As mentioned, this framework is based on a continuum, a constant circle to continuously improve the care that is provided. Based on the results of this project, we can still strive to improve the quality of care that we provide and improve the glycemic control of these patients.

ETD_10647

DNP

Includes bibliographical references

doi:10.7282/t3-fw4q-0w67

ETD doctoral

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