Perceptions and Barriers to Implement Perioperative Glucose Control Protocol among Perioperative Nurses

Abstract

Backgrounds: Strict blood glucose control is essential in preventing surgical site infection (SSI) for perioperative patients. In order to prevent SSIs caused by perioperative hyperglycemia, an evidenced-based protocol has been developed, but there are restrictive challenges for many healthcare organizations to adhere to these protocols to guide their practice. Purpose: The purpose of this quality improvement project is: 1) to determine the perioperative nurses’ perceptions and understanding of the perioperative glycemic management protocol, and 2) explore the perceived barriers of perioperative nurses when implementing the current protocol. Methods: This project used a qualitative descriptive methodology. Semi-structured telephone interviews with open questions were undertaken to collect individual nurses’ perceptions and experiences. A total of six nurses who deliver direct patient care to surgical patients in the preoperative or postoperative units voluntarily participated this project. Interviews were audio-recorded and transcribed verbatim in preparation for analysis. Descriptive statistics and thematic analysis were used to analyze the data. Results: The majority of participants had a positive attitude towards the protocol and reported an awareness and somewhat familiarity with the content of the current hospital perioperative glycemic management protocol currently used in the hospital. Most of the participants appropriately reflected their knowledge on the target populations in whom blood glucose monitoring is required. The protocol implantation barriers identified by perioperative nurses are into three categories, including policy-related barriers, hospital-related barriers and person-centered issues. Facilitators to improve adherence to protocol include education, communication modality, adequate equipment, and easy-to-access protocol format, such as, quick cards. Conclusion: Understanding perioperative nurses’ perception and attitudes are important for the implementation of perioperative glucose control protocol. The existing knowledge gap, broken communication channel, unclear perioperative goal, unstandardized order for hyperglycemia treatment, and frequent policy changing set the barrier for the protocol implementation, which highlight the needs for education and routine meeting to overcome the identified barriers on the policy-related, individual and organizational level. The identified barriers and facilitators in the project may offer the recommendations to the implementation strategies and promote protocol compliance level in practice.