EGEC Wins Quality Improvement Award

December 06, 2011

The Elgin Gastroenterology Endoscopy Center (EGEC), owned by physicians of the Illinois Gastroenterology Group, has received the AAAHC Institute for Quality Improvement 2011 Bernard A. Kershner Innovations in Quality Improvement Award. The center’s winning activity was a blood sugar study focused on determining whether significant fluctuations in blood sugar occur in diabetics undergoing sedated endoscopic procedures, as well as whether the type of intravenous solution used (with dextrose or not) during the procedure contributes to any fluctuations in blood sugars in these patients.

Based on the answers to these two queries, the study also sought to standardize IV solutions to protect diabetic patients from significant fluctuations in blood sugar during their procedures at EGEC.

Pre- and post-procedure blood sugars (finger sticks) were obtained on diabetic patients (N=109) by nursing staff over a two-month period. Those patients with pre-procedure glucose levels below 150 were given D5/0.9NS. Those diabetics with pre-procedure glucose levels above 150 were given 0.9NS.

These interventions were chosen because EGEC did not want to provide additional sugar (dextrose) for patients who already had elevated blood sugar levels and increase these patients’ chances of hyperglycemia.

Key results included:

There were spikes as high as 411 mg/dl in the D5/0.9NS group. This was quite concerning, as this group of diabetics had relatively normal blood sugars (75–150) at the start of the procedure.
Significant fluctuations in blood sugar levels occurred in the diabetic group infused with D5/0.9NS in spite of receiving relatively small amounts of dextrose. The average amount of sugar administered was equivalent to a can of soda.
Diabetic patients who started the procedure with slightly elevated blood sugar levels and received 0.9NS ended the procedure with slightly low blood sugar levels.
The group receiving 0.9NS had almost no change in their blood sugars before and after the procedure, while there were significant fluctuations in blood sugar for diabetic patients receiving D5/0.9NS.

As a result of these findings, the IV solution was changed to 0.9NS and no diabetics were given dextrose during any procedure. Dextrose was not infused during a second trial (re-measurement period) because of the significant increase in blood sugar noted during the initial measurement phase.

In the re-measurement phase, pre- and post-procedure blood sugar assessments were conducted on 62 diabetic patients and fluctuations were again assessed. Using only 0.9NS, the average change in blood sugar (mg/dl) was -1.4 with median change in blood sugar (mg/dl) of -4.0.

Therefore, EGEC decided to use either 0.9NS or lactated ringers as the primary IV solution during endoscopic procedures. Neither contains sugar and both are cost-effective. Blood sugars will continue to be monitored as part of normal ongoing patient safety measures.

Study findings were communicated to EGEC nursing staff, physicians and the board of directors so that this new practice can be supported across the organization.