Date of Award

6-24-2016

Degree Name

Nursing (D.N.P.)

Department

College of Nursing

First Advisor

Dianne Conrad

Second Advisor

Amy Manderscheid

Third Advisor

Amisha Wallia

Abstract

Over 30,000 people receive a solid organ transplant each year, with 5-30% developing post-transplant diabetes mellitus (PTDM) (United Networking for Organ Sharing, 2015). At a Midwestern transplantation center, over 22% of patients with a history of diabetes were not consulted to endocrinology after kidney and liver transplantation. With poor glycemic control, there is an increased risk of developing PTDM leading to poor outcomes. Utilizing the Donabedian model and the Six Sigma’s Define, Measure, Analyze, Improve, and Control (DMAIC) as guides for implementation, the purpose of this project was to address the process measures of increasing appropriate consultations for evaluation and treatment of PTDM patients that would lead to an important quality measure of improved glycemic control for this population. The project involved the implementation of a clinical pathway to address this quality measure. Even though there was not a statistically significant change in number of consultations, there was a clinical meaningful difference because the patients who were consulted after pathway implementation received the benefit of management by endocrinology specialists to improve glycemic control post transplantation. Limitations of the project leading to the reported results include that the sample size was less than 30 and the period of evaluation was only one month. The recommendation is for transplant and endocrinology teams to continue to work together to develop clinical pathways to appropriately consult endocrinology teams that is consistent with the standardized care of other organ transplants. Though this is a small piece to a larger problem, the use of standardized pathways will potentially improve care leading to improved glycemic control in the kidney and liver transplant population. Early consultation immediately after surgery will potentially improve the transitions of care from inpatient to outpatient setting for this patient population.

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