Researchers have established that the best way of limiting complications that may arise from CABG procedures is to ensure that patients are effectively managed throughout their hospital care. Most importantly since hyperglycemia has been linked as one of the leading causes of complications, it is essential that critical care nurses adopt strict glycemic control practices. Aragon (2006) agrees that glycemic control is a critical and essential strategy to manage complications from CABG procedures arguing that blood glucose levels kept within acceptable ranges will result in improved patient outcomes. Similarly Vogelzang et al.
(2007) also argues for strict glucose control in order to ensure lower mortality and morbidity in CABG patients. Ingels et al. (2006) also support that the effects of proper glucose control have a lasting effect on patient outcomes even on a long-term basis. They noted that patients who had undergone CABG and received strict blood glucose management were still better off than their counterparts at four years follow-up. Surgical site infections, specifically DSWIs were also observed to decrease in the presence of strict glycemic control, maintaining blood glucose levels below 200 mg/dL (Lorenz et al.
, 2005). Length of stay in hospital is also improved (Pennel et al. , 2005). Significance of the Study It is the duty of critical care nurses to ensure that the best care is offered to patients and that complications and other negative outcomes are kept to a minimum. Since strict glycemic control, maintaining blood glucose levels below 200 mg/dL has been shown to result in less complications, it is imperative that nurses adopt appropriate practices to ensure that the blood glucose of all patients is kept within the safety standards.
Previous studies have either been experimental, examining the benefits of one type of glucose management regime over another (Hruska et al. , 2005; Smith, Smith, Hendy, Fritz & McAdams, 2005), used only one data gathering methodology, hospital database/medical records (Cheng, 2004), to gather information, or examined diabetic and non-diabetic patients in isolation (McAlister, Mann, Bistritz, Amad & Tandon, 2003). The current study is unique in that it will employ two data gathering techniques.
The medical records of diabetic and non-diabetic patients who have undergone CABG procedures within the past five years at a single hospital intensive care unit will be gathered as well as a questionnaire issued to nurses to understand the factors that impact their adherence to proper management of hyperglycemia in CABG patients. From this study it will be possible to compare the outcomes of diabetic and non-diabetic patients, in order to understand any mechanism within either group that makes them more susceptible to complications. Methodology
This will be a prospective, mixed methods study, gathering both quantitative and qualitative data. Quantitative data on number of patients undergoing CABG procedures in the intensive care unit of a 450 bed, not for profit hospital in Florida will be gathered by examining the medical records of patients. The researchers will determine eligibility and obtain demographic data from patients’ charts for those patients meeting the inclusion criteria. Other data to be gathered will be date of admission, date of surgery, admission status, diabetic status and operative time.
Patients must have undergone isolated CABG procedures within the five year study period. Patients undergoing additional procedures at the time of the CABG will also be excluded. Patients have to be adults and able to give their informed consent. They must not have reported for any other cardiac procedure prior to the CABG procedure. Both diabetic and non-diabetic patients will be included in the study. Preoperative blood glucose levels will be gathered for all patients and subsequently monitored daily by following patients’ charts to determine presence of hyperglycemia and elevation of blood glucose.
The outcomes that will be examined in this study are length of stay, presence of infection, surgical site infections, renal failure, readmission to the ICU, return to theatre, bleeding, deep sternal wound infection and mortality. All patients reporting for CABG procedures and meeting the eligibility criteria will be asked to participate in the study. Patient outcomes will be monitored prior to, during and following their surgical procedure, and will track patients up to the point of their discharge and 30 days subsequently as reports have shown that these are the critical times when negative outcomes are manifested (Yap et al.
, 2007). Quantitative data will be gathered using a researcher-designed questionnaire that nurses working with CABG patients will be asked to complete. This questionnaire will ask nurses to describe their experiences working with CABG patients and to specify any challenges they may have in adhering to proper postoperative management of such patients. Nurses will also be ask to indicate best practices in their management of CABG patients.
This information will be useful to understand any obstacles that may prevent nurses from being compliant with guidelines and help hospital administrators make decisions to improve where practices do not meet standards. For purposes of statistical analysis patients will be assigned to four groups based on their outcomes at the end of the study period and their diabetic status. The first group will be made up of diabetic CABG patients who did not report any serious negative outcomes, that is, they had less than three of the indicated outcomes.
The second group will consist of non-diabetic CABG patients who did not report any serious negative outcomes. The third group will consist of diabetic patients who reported at least three negative outcomes and the fourth group will consist of non-diabetics who reported at least three negative outcomes. Logistic regression analysis will be used to determine the factors that are associated with either better or worse patient outcomes from baseline measures. Multivariate analysis and one-way ANOVAs will be used to determine inter group correlations.
Chi-Square tests will be ran to determine outcomes with significant correlations with p values set at . 05. T-tests will be run on outcomes that demonstrate some level of significance. Content analysis will be used to assess the quantitative data. Multiple readings of responses will be done and common themes found and items grouped together based on their similarities.
References Aragon, D. (2006). Evaluation of nursing work effort and perceptions about blood glucose testing in tight glycemic control.
American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses, 15(4), 370-377. Centers for Disease Control. (2007). Estimates of health-care associated infections. Retrieved March 27, 2008, from http://www. cdc. gov/ncidod/dhqp/hai. html Cheng, A. Y. (2004). Does tighter perioperative glycemic control improve outcomes for diabetic patients undergoing coronary artery bypass graft surgery? Canadian Medical Association Journal, 171(1), 30-31.