How Does Ozempic Impact Patients’ Recoveries - and Your Facility’s Processes?

Ophthalmology Patient Safety Patient Experience

By: Jay Horowitz, CRNA, APRN, Brooke Newsom and Chase Newsom

Published: 2/13/2024

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Our ASC’s assessment of GLP-1 medications’ influence on perioperative glucose levels led to a more cost-effective and efficient policy.

There has been an enormous amount of media attention and general buzz surrounding the new glucagon-like peptide-1 receptor agonist (GLP-1) medications semaglutide (brand names Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound). This is due to their amazing effects on weight loss and symptoms related to obesity (such as cardiac disease and hypertension), their astronomical costs and their nasty side-effects. In fact, you’d likely have trouble finding anyone who isn’t aware of these “miracle drugs” at this point.

Within anesthesia literature, special attention is being paid to these drugs due to the delayed gastric emptying time in patients undergoing general anesthesia for their surgeries. Aside from weight loss, GLP-1s are regularly prescribed alone or in combination with other medications like metformin and insulin in the treatment of Type 1 and Type 2 diabetes. At our facilities — the Newsom Surgery Center of Sebring and Tampa Surgery Center, both in Florida — we decided to conduct our own in-house research into the effects of these popular medications.

Background

The research is a natural progression of another study we did — one which garnered recognition and accolades from this very magazine. In the September 2022 OR Excellence edition of Outpatient Surgery Magazine, we earned an Honorable Mention for our in-house examination of pre- and postoperative glucose levels on patients taking medications for diabetes — and how those levels impacted the efficiency of our surgical processes.

Through our research, we discovered that 71% of diabetic patients had an average 18% decrease in their blood glucose levels between pre- and post-op. That’s a major problem. While nurses in the PACU can easily help a patient with low blood sugar by giving them juice or administering dextrose 5% (D5W) intravenously, the patient still must be held for at least an extra 30 minutes before being discharged. That delay can wreak havoc on the schedule and throughput of any high-volume surgery center. Our solution: Treat low blood sugar before it becomes a problem.

We determined that those patients who take medicines for diabetes such as insulin, metformin, Actos, etc., and who arrive with a blood glucose level of 122 or below regardless of NPO status will be given D5W IV to prevent their levels from dropping perioperatively and requiring postoperative intervention from our staff. In high-volume, fast-paced practices like ours, any delay in discharge has a ripple effect on our overall efficiency and throughput. Low-glucose interventions divert nursing personnel and keep stretchers and post-op space occupied.

The next phase

Jay Horowitz
BLOCK TIME Jay Horowitz, chief CNRA for Newsom Eye, performs regional anesthesia for a patient prior to an upcoming ophthalmic case.

As a follow-up to the research just described, we looked at our patients who are only on the new GLP-1 medications — whether for diabetes, weight loss or both. We evaluated whether these patients should be treated like our patients on non-GLP-1 diabetes medications or whether they were different and don’t require D5W to prevent post-op hypoglycemia.

We reviewed 24 patients over two months at the end of 2023 at our Sebring facility and our Tampa Surgery Center — single-specialty ASCs where we do not provide general anesthesia — and we found very small drops in glucose levels (7% for semaglutide and 3% for tirzepatide) pre-op vs. post-op. Based on these findings, we made it our policy not to administer IV D5W unless the patient presents with a blood glucose level below 70. Here’s why this move matters: Our patients are generally in the facility about 1.75 hours from admission to discharge. Not administering IV D5W is a cost- and time-saving practice, as we do not waste the IV fluids, tubing, etc., or keep patients in the post-op area for additional time.

Patient-driven experiences that challenge the status quo and provide life-changing experiences through better vision in a progressive, cutting-edge environment are among the core values and critical focus areas of Newsom Eye. Continuous assessments of our policies and procedures allow us to actualize our focus and values. After all, seeing is believing! OSM

BEST PRACTICES
5 Keys to In-House Research

Surgical facilities should always be looking for safer, more efficient and cost-effective ways to improve their processes and protocols. This involves continuously testing what’s working and what’s not — and adjusting the key steps accordingly. For major health systems and academic facilities, this often involves formal research. But for smaller centers with limited resources, this process is less about producing scientific studies and more about evaluating and assessing current practices with an eye on areas of improvement. Accreditation entities like AAAHC require evidence of Quality Improvement activities, and these kinds of assessment activities often meet that requirement. Here are key elements of such evaluations:

• Identify the issue. Look for small opportunities to provide safer, faster, cheaper and ultimately better care. Are your discharge times not where they should be? Are PONV rates ticking upward? Are there bottlenecks in your SPDs? These are the types of focus areas facilities can assess regularly.

• Make it convenient for patients and staff. When we conducted our two studies of diabetic patients, our center had already been checking blood sugar levels, so it wasn’t a major hassle for our patients — nor was it labor-intensive for staff.

• Do the study (but don’t call it a study). Once you commit, it’s critical to follow through with the process. I’ve always found that it’s much easier to get buy-in if you avoid calling what you’re doing a study, which often causes staff to think extensive time and resources are needed. Instead use terms like “assessment” or “evaluation.”

• Gather the data. Again, it doesn’t need to be onerous — and in most cases it shouldn’t be. In our case, we simply took the data we’d gathered from the bedside and transferred it over to spreadsheets that broke it all down for us.

• Evaluate the results. This is the fun part — the step that (hopefully) leads to policy changes that improve your facility.

— Jay Horowitz, CRNA, APRN

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