Date of Graduation

2017

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Adult Health

Committee Chair

Jennifer Mallow

Committee Co-Chair

Kendra Barker

Committee Member

Renee Schwertfeger

Abstract

Background: Uncontrolled diabetes during the perioperative period can result in increased postoperative infections, increased length of stay, increased ICU admissions, increased risk of myocardial infarction, stroke, and mortality. In addition, mortality rates of patients with diabetes are likely to be up to five times higher than patients without diabetes. Postoperative infections account for 66% of complications and one quarter of perioperative deaths. As a result of these findings, it is imperative that patients with diabetes maintain glycemic control in order to minimize infection, postoperative complications, and improve surgical outcomes.;Objective: The objective of the pilot project was to determine if an APRN telephone follow-up call would decrease fasting glucose levels the day of surgery for patients with uncontrolled Type 2 diabetes based on Kotter's change model. The change process involved patients with HgA1c over 7% receiving an APRN follow-up telephone call. The telephone intervention provided evidence based education on 7 self-care behaviors essential for self-management of diabetes. Evaluation of the pilot project was based on fasting glucose levels the day of surgery and amount of time to make follow-up calls.;Methods: The PICO question that guided this review was, "In adult surgical patients with Type 2 diabetes and elevated HgA1c > 7%, does patient education via telephone intervention compared to usual care, result in decreasing fasting blood glucose the day of surgery?" After searching the most pertinent articles, substantial evidence was found to support the practice change. Seventeen articles were obtained for inclusion, two systematic reviews, fourteen random controls, and one quasi-experimental. The intervention for this pilot project included diabetes education via a telephone follow-up call using the AADE7, which is an evidence based and patient centered framework of seven self-care behaviors that are essential for effective self-management of diabetes. A SMART plan provided guidance for development of the pilot project and the practice change was guided by Kotter's change model. Fifty participants were included in the pilot project. Twenty-five participants were randomly assigned to receive the intervention and twenty-five participants were randomly assigned to the control group.;Results: The follow-up APRN telephone call was done with 25 participants in the intervention group and 25 in the control group. Both groups had a reduction in the mean post-intervention glucose level from the random preoperative glucose levels. One-way ANOVA determined that there was no statistical difference between the control and intervention group p= 0.668. Although results were not statistically different, four participants in the intervention group postponed surgery, perhaps preventing an adverse outcome. Conversely, all 25 participants in the control group completed their surgery.;Discussion: Although the findings from this pilot project were not statistically significant, there may be some clinical significance in four participants choosing to delay surgery and potentially preventing adverse outcomes associated with hyperglycemia. Findings from the literature support an APRN follow-up telephone call for patients with uncontrolled Type 2 diabetes. Optimization of patients with uncontrolled diabetes is crucial in order to improve negative surgical outcomes associated with hyperglycemia.

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