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Reducing inpatient hypoglycaemia

Reducing inpatient hypoglycaemia. Alison Melvin Lesley Cowley. Aims. To improve appropriate treatment of hypoglycaemia as per Trust guideline rapid acting carbohydrate eg lucozade followed by complex carbohydrate if not prior to meal ( ie before bed/during night)

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Reducing inpatient hypoglycaemia

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  1. Reducing inpatient hypoglycaemia Alison Melvin Lesley Cowley

  2. Aims • To improve appropriate treatment of hypoglycaemia as per Trust guideline • rapid acting carbohydrate eglucozade followed by complex carbohydrate if not prior to meal (ie before bed/during night) • To reduce incidence of recurrent hypoglycaemia by 30% • Referral to inpatient Diabetes Specialist Nurse • Education to enable medical teams to manage dibates more effectively

  3. What did we do? • Set up Think Glucose Oct 2010 • Concentrating on insulin safety • Regularly reviewing hospital reported incidents (containing word “Insulin”) • Realised that this was missing hypos • Re-designed insulin prescription chart which incorporated CBGM • Ongoing ward based training around hypoglycaemia

  4. Money!!!!!

  5. CQUIN hypoglycaemia

  6. Problem! • Resources • One part time consultant • One overworked DISN • No more staff!

  7. Making help from not much • Encouraged some pharmacists to help us • Watching for insulin incidents • Part of Think Glucose team • Helping design new charts • Link nurses to do some of the monthly audits and raise awareness on wards • Involvement of senior management (Head of Nursing and matrons) • Dietetic input

  8. CQUIN - hypoglycaemia

  9. CQUIN Part 2 - % recurrent hypos

  10. CQUIN part 1 - % correct management of hypos

  11. What has worked • Persistence with message – much higher awareness in Trust • Following up all incidents • Specific training for junior doctors, consultants, individual training for nurses • Zero tolerance attitude from us • Praise wards which have done well in monthly audits • Feed back to ward/teams who have not done well • Institution of bedtime snack for all DM patients

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