RT Journal Article
SR Electronic
T1 Perioperative variable rate intravenous insulin infusion: a quality improvement project on a vascular surgery ward
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e002048
DO 10.1136/bmjoq-2022-002048
VO 12
IS 1
A1 Kelsey Aimar
A1 Nikola Orozov
A1 Keely Spencer-Jones
A1 Hafsa Burhan
A1 Nicola Butler
A1 Saifuddin Kassim
A1 James Forsyth
YR 2023
UL http://bmjopenquality.bmj.com/content/12/1/e002048.abstract
AB Aims Variable rate intravenous insulin infusion (VRIII) is used perioperatively to maintain normoglycaemia in patients with diabetes who are undergoing surgery. The aims of this project were as follows: (1) to audit the extent to which perioperative prescribing of VRIII for diabetic vascular surgery inpatients at our hospital meets established standards and (2) to use the results of the audit to guide improvement in the quality and safety of prescribing practices and reduce VRIII overuse.Methods Vascular surgery inpatients who had perioperative VRIII were included in the audit. Baseline data were collected consecutively from September to November 2021. There were three main interventions: a VRIII Prescribing Checklist, education of junior doctors and ward staff, and electronic prescribing system updates. Postintervention and reaudit data were collected consecutively from March to June 2022.Results The number of VRIII prescriptions totalled 27 in preintervention, 18 in postintervention and 26 in reaudit periods. Prescribers used the ‘refer to paper chart’ safety check more frequently postintervention (67%) and on reaudit (77%) compared with preintervention (33%) (p=0.046). Rescue medication was prescribed in 50% of postintervention and 65% of reaudit cases compared with 0% preintervention (p<0.001). Intermediate/long-acting insulin was appropriately amended more often in the postintervention versus preintervention period (75% vs 45%, p=0.041). Overall, VRIII was appropriate for the situation in 85% of cases.Conclusions The quality of perioperative VRIII prescribing practices improved following the proposed interventions, with prescribers more frequently using recommended safety measures such as ‘refer to paper chart’ and rescue medication. There was a marked sustained improvement in prescriber-initiated adjustment of oral diabetes medications and insulins. VRIII is occasionally administered unnecessarily in a subset of patients with type 2 diabetes and may be an area for further study.Data are available on reasonable request.