(296) A Protocolized Transition From Insulin Infusion to SubQ in Patients Undergoing Cardiac Surgery

Introduction: Few validated approaches exist for the transition from intravenous insulin infusion to subcutaneous insulin post-operatively in cardiothoracic surgery patients. We aim to assess whether a pharmacist-driven protocol utilizing either basal/nutritional/correctional or correctional only subcutaneous insulin is both safe and efficacious for post-operative glycemic control following 24-hours of intravenous insulin administration.

Methods: A retrospective, single-center, observational study investigating clinical outcomes associated with a pharmacist-driven protocol utilizing basal/nutritional/correctional or correctional insulin from May 2023 through July 2023 as compared to a historical nursing-driven protocol observed from May 2021 through July 2021. Adult cardiac intensive care unit patients, who have received an insulin infusion within 24 hours of cardiothoracic surgery and subsequently transitioned to subcutaneous insulin were observed. The primary outcome was percent time in goal blood glucose (BG) range (140-180 mg/dL). Secondary outcomes included percent time in clinically acceptable BG range (110-180 mg/dL), hypoglycemia < 70 mg/dL, severe hypoglycemia < 40 mg/dL, administration of rescue dextrose, further insulin infusion usage following transition, and surgical site infection.

Results: Use of a pharmacist-driven protocol improved time in goal BG range when compared to a nursing driven protocol (24.4% vs 12.4%, p = 0.001). There was a difference favoring the pharmacist-driven protocol for the clinically acceptable BG range: 69.6% time in range for the pharmacist-driven group versus 58.5% for the nursing-driven group (p = 0.011). There were fewer observed hypoglycemic events in the pharmacist-driven arm. There were no instances of severe hypoglycemia, further intravenous insulin requirements, or surgical site infections in either group. Pharmacist compliance to the protocol was high at 92.4%.

Conclusions: A pharmacist-driven protocolized approach to the transition to subcutaneous insulin post-operatively in cardiothoracic patients is both safe and effective. The pharmacist-driven protocol had improved time in goal blood glucose range and observed less hypoglycemic events than the historical nursing-driven protocol.