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Background: Uncontrolled diabetes during the perioperative period can result in increased postoperative infections, increased length of stay, increased ICU admissions, increased risk of myocardial infarction, stroke, and mortality. In addition, mortality rates of patients with diabetes are likely to be up to five times higher than patients without diabetes. Postoperative infections account for 66% of complications and one quarter of perioperative deaths. As a result of these findings, it is imperative that patients with diabetes maintain glycemic control in order to minimize infection, postoperative complications, and improve surgical outcomes. Objective: The objective of the pilot project was to determine if an APRN telephone follow-up call would decrease fasting glucose levels the day of surgery for patients with uncontrolled Type 2 diabetes based on Kotter’s change model. The change process involved patients with HgA1c over 7% receiving an APRN follow-up telephone call. The telephone intervention provided evidence based education on 7 self-care behaviors essential for self-management of diabetes. Evaluation of the pilot project was based on fasting glucose levels the day of surgery and amount of time to make follow-up calls. Methods: The PICO question that guided this review was, “In adult surgical patients with Type 2 diabetes and elevated HgA1c > 7%, does patient education via telephone intervention compared to usual care, result in decreasing fasting blood glucose the day of surgery?” After searching the most pertinent articles, substantial evidence was found to support the practice change. Seventeen articles were obtained for inclusion, two systematic reviews, fourteen random controls, and one quasi-experimental. The intervention for this pilot project included diabetes education via a telephone follow-up call using the AADE7, which is an evidence based and patient centered framework of seven self-care behaviors that are essential for effective self-management of diabetes. A SMART plan provided guidance for development of the pilot project and the practice change was guided by Kotter’s change model. Fifty participants were included in the pilot project. Twenty-five participants were randomly assigned to receive the intervention and twenty-five participants were randomly assigned to the control group. Results: The follow-up APRN telephone call was done with 25 participants in the intervention group and 25 in the control group. Both groups had a reduction in the mean post-intervention glucose level from the random preoperative glucose levels. One-way ANOVA determined that there was no statistical difference between the control and intervention group p= 0.668. Although results were not statistically different, four participants in the intervention group postponed surgery, perhaps preventing an adverse outcome. Conversely, all 25 participants in the control group completed their surgery. Discussion: Although the findings from this pilot project were not statistically significant, there may be some clinical significance in four participants choosing to delay surgery and potentially preventing adverse outcomes associated with hyperglycemia. Findings from the literature support an APRN follow-up telephone call for patients with uncontrolled Type 2 diabetes. Optimization of patients with uncontrolled diabetes is crucial in order to improve negative surgical outcomes associated with hyperglycemia. TELEPHONE	  EDUCATION	  TO	  DECREASE	  FASTING iii GLUCOSE	  PRIOR	  TO	  SURGERY Acknowledgements First I would like to start off by thanking my husband Ken for all of his love and support during this journey. I would not have been able to complete this journey without you. You stepped up during my absence and for that I’m grateful. I’m also grateful for my children Kayla and Konnor. You make me want to strive to be the best and I hope my dedication and drive inspires you to believe in yourself and know that you can achieve anything in life. I would also like to thank my best friend Terri Marchischak. Without your support and friendship I would never have accomplished everything that I have done. You have always pushed me to go beyond what I could have imagined for myself academically. Finally, I would like to thank my family for always believing in me and only wanting the best for me. My twin sister Crystal Foreman has been there to support me during this process. My parents Kay and Gordon Martin have always encouraged me to reach for the stars. My sister Kim Boehman and Mike Martin also provided support and encouragement. Professional I would like to thank Dr. Jen Mallow. It has been a pleasure to have your guidance and friendship. You pushed me to excel and believed in my ability to achieve excellence. I would also like to thank Dr. Kendra Barker and Renee Schwertfeger who were part of my committee. Your guidance and feedback along with knowledge was a source of value for me and my project. I value your expertise and friendships. Finally, I would like to thank the staff in the Preoperative Evaluation Center and WVU Medicine. Several members of the healthcare team played a valuable role. Tracy Brinegar played a key role in the project, along with the medical assistants, RNs, and TELEPHONE	  EDUCATION	  TO	  DECREASE	  FASTING iv GLUCOSE	  PRIOR	  TO	  SURGERY APRNs. I could not have asked to have a better group of colleagues. A special thanks to Kaneetha Davis and Beth Stepak who were the lead RNs and helped to consent participants. You both were willing to help out and do whatever was needed to make the project a success. To the APRNs in the PEC Monique Bandy, Patty Hermosilla, Stacy Maltese, Terri Marcischak, Linda Metcalfe, Jen Molina, Janae Sherer, Billie Vance, Kym Wallace, Joy Williams, and Cindy Zemerick. You were instrumental in helping me to achieve this pilot study and recruiting participants. I feel honored to work with such a wonderful group of advanced practice providers. This project was truly a group effort and I appreciated everyone’s willingness to be involved with the pilot study. TELEPHONE	  EDUCATION	  TO	  DECREASE	  FASTING v GLUCOSE	  PRIOR	  TO	  SURGERY

Using Telephone Education to Decrease Fasting Blood Glucose Prior to Surgery