Inpatient Hypoglycaemia Management
C. Sobajo & P. Rao-Balakrishna
Introduction: Inpatient hypoglycaemia management remains a significant challenge. An audit in 2009 revealed poor understanding (recognition by frontline staff) of the need to treat and manage hypoglycaemia. Consequently a management protocol, documentation sheet and hypoboxes with standardized quantities (15 g) of dextrose in various forms were introduced throughout the hospital.
Aims: We re-audited inpatient hypoglycaemia management and the impact of the standardized hypo-boxes and guidelines.
Methods: For the purposes of these audits, hypoglycaemia, was defined as capillary blood glucose (CBG) ≤4 mmol/l and Recognition by staff as identifying the low CBG and initiating treatment. On a single day, 126 diabetes inpatients were identified, of whom n=33 had ≧1 episode(s) of hypoglycaemia totaling 62 events, as evidenced by their CBG. Data relating to recognition and management of the event(s) by the staff was collected and compared with the 2009 audit.
Results: Similar numbers of inpatients with diabetes experienced hypoglycaemia in 2009 (n=32/120) and 2011 (n=33/126), but the total episodes decreased from 79 to 62. Frontline staff failed to recognize hypoglycaemia in n=12 (36% of 33). Only 64% of the initial and 27% of the subsequent management was appropriate despite the new management tools. Recognition and management was better when events were recurrent (100% at >4 recurrences). Recovery from hypoglycaemia was confirmed in 24% in 2011 vs only 6% in 2009. Documentation in notes; ranged from 12% with one event and 55% with ≧4 events compared to 3% and 13% in 2009. Medication-review and diabetes-team referral improved by 6% and 15% respectively. Introduction of the hypo-box was considered beneficial by 73% of frontline staff.
Conclusions: Introduction of hypoboxes and guidelines have led to improved reassessment and documentation after treatment and the benefit reflected by the fewer number of recurrent hypos. Further guidelines to proactively decrease the incidence of hypoglycaemia are planned.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.