Measure Abbreviation
GLU-04
Data Collection Method

This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data.  This measure is explicitly not based on provider self-attestation.

Measure Type
Process
Description

Percentage of cases with perioperative glucose <60 with administration of glucose or dextrose containing solution or glucose recheck within 90 minutes of original glucose measurement.

 

Measure Time Period

Preop through PACU (see ‘Other Measure Build Details’ for more information)

Inclusions
  • All patients with glucose level less than 60 mg/dL
  • Patients with and without diagnosis of diabetes
Exclusions
  • ASA 5 and 6 cases
  • Glucose measurements < 60 mg/dL within 90 minutes before measure end (‘See Other Measure Build Details’ for more information)
  • Obstetric Non-Operative Procedures- CPT 01958, 01960, 01967
  • Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”
Success
  • Administration of glucose or dextrose containing solution within 90 minutes (IV)

OR

  • Recheck of glucose level within 90 minutes
Other Measure Build Details
  • Measure start time is determined by MPOG Phenotype 'Preop Start Time'
  • Meaure end time is determined by MPOG Phenotype 'PACU End Time"
Responsible Provider

Not applicable.

Threshold
90%
MPOG Concept IDs Required

Dextrose MPOG Concept IDs

Glucose MPOG Concept IDs

10152

Dextrose

3361

POC- Glucose (Fingerstick)

10153

Dextrose 50%

3362

POC- Glucose

(Unspecified Source)

10460

Dextrose / Water 5%

3405

POC- Blood Gas- Glucose

10461

Dextrose / Lactated Ringers 5%

5003

Formal Lab-Glucose,

Serum/Plasma

10462

Dextrose / Water 10%

5036

Formal Lab-Blood Gas,

Glucose

10465

Dextrose / Saline 5% / 0.225%

 

10466

Dextrose / Saline 5% / 0.45%

 

10467

Dextrose / Saline 5% / 0.9%

 

10468

Dextrose / Saline w/KCl 5%/ 0.45% + 20 MEQ/L

 

10469

Dextrose / Saline w/KCl 5%/ 0.9% + 20 MEQ/L

 

10470

Dextrose / Saline 10% / 0.45%

 

10539

Dextrose 10% w/ Lactated Ringers

 

10548

Plasmalyte 148 w/ Dextrose 5%

 

10558

Dextrose / Saline w/KCl 5%/ 0.225% + 20 MEQ/L

 

10559

Dextrose / Saline w/KCl 5%/ 0.45% + 40 MEQ/L

 

10588

Dextrose / Saline w/KCl 10%/ 0.225% + 20 MEQ/L

 

10594

Dextrose / Saline w/KCl 5%/ 0.45% + 10MEQ/L

 

10602

Dextrose / Saline 10% / 0.225%

 

10471

Total Parenteral Nutrition

 

10530

Peripheral Parenteral Nutrition

 

10777

Dextrose / Saline w/KCl 10% / 0.225% + 10MEQ/L

 

10778

Dextrose / Saline w/ KCl 10% / 0.45% + 10MEQ/L

 

10783

Dextrose / Saline 12.5% / 0.45%

 

10784

Dextrose / Water 25%

 

10785

Dextrose / Water 12.5%

 

10787

Dextrose / Water 3%

 

10780

Dextrose / Saline w/KCl 5% / 0.225% + 10MEQ/L

 

10781

Dextrose / Saline w/KCl 10% / 0.9% + 10MEQ/L

 

10786

Dextrose / Water 15%

 

10782

Dextrose / Saline w/KCl 5%/ 0.9% + 10 MEQ/L

 

10260

Dextrose / Sodium Acetate 10% / 19.5 MEQ

 

10613

Dextrose / Sodium Chloride 5% / 0.3%

 

10614

Dextrose / Sodium Chloride / Potassium Chloride 10% / 0.225% / 1.5 MEQ

 

10615

Dextrose / Sodium Chloride / Potassium Chloride 5% / 0.45% / 1.5 MEQ

 

10622

Dextrose / Saline 10% / 0.9%

 

10623

Dextrose 25%

 

10647

Dextrose / Saline w/ KCL 5% / 0.9% + 40 MEQ/L

 

10667

Dextrose / Saline 12.5% / 0.225%

 

10672

Dextrose 10% / Unspecified Solution

 

10673

Heparin w/ Dextrose Solution

 

10674

Dextrose / Saline w/KCL 10% / 0.9% + 20 mEQ/L

 

10676

Dextrose 5% / Unspecified Solution

 

10715

Dextrose / Saline 12.5% / 0.9%

 

10723

Dextrose / Water w/ KCL 5% / 10mEQ/L

 

10724

Dextrose / Saline w/KCL 5% / 30 mEQ/L

 

10725

Dextrose 20%

 

10734

Dextrose / Sodium Acetate / Magnesium Sulfate 10% / 80mEQ / 10mEQ/L

 

10782

Dextrose / Saline w/ KCL 5% / 0.9% + 10mEQ

 

10786

Dextrose / Water 15%

 

10204

GLUCAGON

 

10796

Glucose Chew Tablet

 

10797

Glucose Gel 40%

 

 

 

Data Diagnostics Affected
  • Percentage of Cases with Insulin Administration Mapped Correctly
  • Percentage of Cases with POC Glucose Labs
  • Percentage of Cases with a Lab Drawn during Anesthesia
  • Percentage of Labs Mapped to a Meaningful Lab Mapping
  • Percentage of Medications with a Meaningful Medication Mapping
  • Percentage of Fluids with a Meaningful Fluid Mapping
Rationale

The American Diabetes Association uses an outpatient hypoglycemia definition of <70 mg/dL6,7. Severe hypoglycemia in inpatients is considered <40mg/dL6. Acute hypoglycemia in the perioperative period can lead to inadequate supply of glucose to the brain, resulting in seizures, permanent brain damage, and death.  In hospitalized diabetic patients, hypoglycemia has been associated with increased length of stay and mortality.5 The risk of negative sequelae related to hypoglycemia is reduced with early recognition and treatment of mild to moderate hypoglycemia (40-69mg/dL)6,8,9. The common signs/symptoms of hypoglycemia are masked by general anesthesia, making vigilance and quick treatment especially important.1 Fasting patients with or without diabetes and diabetic patients treated with oral glycemic agents or insulin are at increased risk of perioperative hypoglycemia.2-3

Perioperative hypoglycemia is a rare event typically caused by the following: 4

  1. Insulin overdose, either by patient taking higher than normal doses on the morning of surgery or by providers giving more insulin than necessary
  2. Septic or circulatory shock
  3. Failure to monitor
Risk Adjustment

Not applicable

References
  1. Akhtar, Shamsuddin, Paul G. Barash, and Silvio E. Inzucchi. 2010. “Scientific Principles and Clinical Implications of Perioperative Glucose Regulation and Control.” Anesthesia and Analgesia 110 (2): 478–97.
  2. Falconer, R., C. Skouras, T. Carter, L. Greenway, and A. M. Paisley. 2014. “Preoperative Fasting: Current Practice and Areas for Improvement.” Updates in Surgery 66 (1): 31–39.
  3. Leung, Vivien, and Kristal Ragbir-Toolsie. 2017. “Perioperative Management of Patients with Diabetes.” Health Services Insights 10 (November): 1178632917735075.
  4. Schwenk, Eric S., Boris Mraovic, Ryan P. Maxwell, Gina S. Kim, Jesse M. Ehrenfeld, and Richard H. Epstein. 2012. “Root Causes of Intraoperative Hypoglycemia: A Case Series.” Journal of Clinical Anesthesia 24 (8): 625–30.
  5. Turchin, Alexander, Michael E. Matheny, Maria Shubina, James V. Scanlon, Bonnie Greenwood, and Merri L. Pendergrass. 2009. “Hypoglycemia and Clinical Outcomes in Patients with Diabetes Hospitalized in the General Ward.” Diabetes Care 32 (7): 1153–57.
  6. Moghissi, Etie S., Mary T. Korytkowski, Monica DiNardo, Daniel Einhorn, Richard Hellman, Irl B. Hirsch, Silvio E. Inzucchi, et al. 2009. “American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control.” Diabetes Care 32 (6): 1119–31.
  7. Cryer, Philip E., Stephen N. Davis, and Harry Shamoon. 2003. “Hypoglycemia in Diabetes.” Diabetes Care 26 (6): 1902–12.
  8. DiNardo, Monica, Michelle Noschese, Mary Korytkowski, and Stephanie Freeman. 2006. “The Medical Emergency Team and Rapid Response System: Finding, Treating, and Preventing Hypoglycemia.” Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources 32 (10): 591–95.
  9. DiNardo, M., A. C. Donihi, M. DeVita, L. Siminerio, H. Rao, and M. T. Korytkowski. 2005. “A Nurse Directed Protocol for Recognition and Treatment of Hypoglycemia in Hospitalized Patients.” Pract Diabetol 22: 37–40.