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| Challenges faced | Solutions employed |
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| Consensus of a need for action by key leaders in representative departments and formation of Task force for perioperative glycemic control | MD leaders in endocrinology and anesthesiology provided education and interdepartmental outreach (e.g. conferences, consultation) on risks of hyperglycemia and reviewed hospital-specific patient outcomes as well as national data and guidelines |
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| Buy-in by providers at other levels of care who are in supportive roles (e.g. nursing, pharmacy, laboratory) and hospital administrators | Task force members met with hospital leaders to explain rationale for intervention and demonstrate leadership endorsement |
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| Designing a practical and effective protocol suited to institutional needs and capabilities | Task force conducted a multidisciplinary assessment of hospital expertise and practice pattern including nursing and anesthesiologist skill in the use of intravenous insulin. Protocols were developed and piloted and further refined prior to institution-wide adoption |
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| Obtaining resources required for program success, including point-of-care glucose meters in preoperative, intraoperative, and postoperative care areas | Representative of the task force worked directly with hospital administrators for funding required for infrastructure and equipment |
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| Staff training, including nursing, anesthesia, and endocrine staff regarding the protocol as well as specific skills in infusion therapy and glucose meters | Nurse educators, pharmacists, and endocrinologists performed education for support staff in the perioperative area. Provider education by each department and leadership group |
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| Ensuring uniformity and ease of daily protocol use | Consistent elements were put in place: computerized order sets, written protocols available in the perioperative areas and 24/7 pager access to a designated physician for support |
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| Protocol maintenance and improvement | Scheduled reviews of efficacy and safety with members from representative departments, easily identifiable point person who can be contacted with questions, concerns, and suggestions |
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