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Screening IDs Hyperglycemia in Joint-Replacement Patients

A simple screening program can identify hyperglycemia in patients undergoing joint-replacement surgery. In one hospital this program helped significantly reduce the problem in this high-risk population.

After a 2-week study of 15 patients scheduled for joint replacement, postsurgical testing revealed that 40% had elevated blood glucose levels, and 3 patients were found to have undiagnosed type 2 diabetes.

"We wanted to find out whether there was a problem in our joint-replacement patient population," says Callie Craig, RN, of Integris Baptist Medical Center, a 561-bed hospital in Oklahoma City.

Craig and her colleague, April Merrill, RN, BSN, BC, inpatient diabetes nurse specialist at Baptist, discussed their data in a poster presented at the 33rd Annual Meeting and Exhibition of the American Association of Diabetes Educators, held August 9–12 in Los Angeles.

People who are undergoing joint-replacement surgery are considered a high-risk population because of the possibility of dangerous bone infection. Many of the patients also are elderly and overweight or obese, which increases their risk. A previous surgical infection prevention project indicated that hyperglycemia might be a problem among these patients.

In 2004, the hospital formed a research team to look into the issue of hyperglycemia among joint-replacement patients. When researchers discovered the high prevalence of postsurgical hyperglycemia, the hospital implemented a protocol to address the problem.

The hyperglycemia protocol calls for treating any joint-replacement surgery patient who has a fasting blood glucose level 140 mg/dl. Since the protocol has been in place, the incidence of hyperglycemia among patients of the hospital's three orthopedic surgeons has dropped from a pre-protocol average of 38.5% to an average of 24%.

Seventeen of the 195 joint-replacement patients included in a follow-up study (8.5%) had glycated hemoglobin (A1C) levels >6.7%, and 6 patients (35%) were identified as having type 2 diabetes.

Based on the success of the hyperglycemia protocol, Baptist Medical Center plans to apply the protocol to all adult surgical inpatients and has created a nurse specialist position to follow all hyperglycemic or diabetic surgical patients in the hospital.

The hyperglycemia protocol eventually may be applied to outpatients and could become a routine part of pre-procedure and pre-admission testing, Craig says.

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goldfarb, B. Search for Related Content PubMed Articles by Goldfarb, B. Social Bookmarking                What's this?