Semester
Summer
Date of Graduation
2024
Document Type
Problem/Project Report
Degree Type
DNP
College
School of Nursing
Department
Not Listed
Committee Chair
Aaron M. Ostrowski
Committee Co-Chair
Jami D. Pincavitch
Committee Member
Jami D. Pincavitch
Committee Member
Eric J. Lindstrom
Abstract
Background: At a local tertiary care hospital, there was no recommendation to guide anesthesia providers in the administration of intraoperative dexamethasone to patients with diabetes. While dexamethasone is a highly effective antiemetic, it may promote hyperglycemia in patients with diabetes.
Purpose: The purpose of this project was to guide and educate about current recommendations for the administration of dexamethasone for PONV prophylaxis in patients with diabetes.
Intervention: 1) Examined pre-intervention practices of dexamethasone administration. 2) Educated about current and best practices to anesthesia staff. 3) Developed badge buddy cards outlining the guideline. 4) Examined post-intervention practices. 5) Evaluated the effect of the guideline.
Methods: Retrospective chart audits were performed for 100 charts. After review, 9 were omitted and the remaining 91 were used for this project. These charts included adult patients with diabetes who were undergoing total joint procedures. Surveys were distributed to anesthesia providers pre- and post-intervention. The Logic Model was used as an evaluation tool.
Results: The pre-intervention relationship between percent change in blood glucose levels and dexamethasone doses was r([45]) = .489, p p = .130, and the relationship between the percent change in blood glucose levels and dexamethasone doses was r([38]) = .20, p = .227. There were 24 respondents for the pre-survey and 15 respondents for the post-survey. Post-survey results determined that 20% of respondents followed an algorithm or guideline to determine whether to give or withhold dexamethasone for patients with diabetes, compared to 0% from the pre-survey group.
Conclusions: The post-intervention group demonstrated a moderate positive relationship between the percent change in blood glucose levels and preoperative fructosamine. Both groups demonstrated positive relationships between percent change in blood glucose levels and dexamethasone doses.
Recommended Citation
Hall, Brittany W., "Implementation of a Pilot Quality Improvement Project to Guide the Administration of Intraoperative Dexamethasone for Postoperative Nausea and Vomiting Prophylaxis in Patients with Diabetes Undergoing Orthopedic Procedures" (2024). Graduate Theses, Dissertations, and Problem Reports. 12505.
https://researchrepository.wvu.edu/etd/12505
Included in
Anesthesiology Commons, Endocrine System Diseases Commons, Endocrinology, Diabetes, and Metabolism Commons, Interprofessional Education Commons, Perioperative, Operating Room and Surgical Nursing Commons, Quality Improvement Commons