Introduction: Inappropriate meal to insulin timing, poor appetite, tight glycaemic control, cardiac, renal or hepatic impairment and sepsis are seen in association with hypoglycaemia. Poor understanding of these risks and management of hypoglycaemia(hypo) remain challenging. Hypo management guidelines and hypoboxes with standardized 15 g of dextrose in various forms were introduced throughout the hospital in November 2010 after an audit in 2009 revealed poor understanding of the need to treat and manage hypoglycaemia by frontline staff.
Aims: We re-audited the impact of the introduction of standardized hypo-boxes and guidelines.
Methods: Hypoglycaemia, was defined as capillary blood glucose (CBG) ≤4 mMol/l and Recognition by staff as initiating action when a low CBG was recorded. 126 diabetes inpatients were identified on a single day, of whom n=33 had ≥1 hypo(s) totaling 62 events. The data on recognition and management of the hypos by the staff was collected and compared with the 2009 audit.
Results: Similar numbers of diabetes inpatients experienced hypoglycaemia in 2009 (n=32/120) and 2011 (n=33/126), but the number of hypos per patient decreased with the total documented hypo episodes declining from 79 to 62. Although recognition and management remained similar to the 2009 audit, repeat CBG checks to assess recovery from hypoglycaemia were more often done as per guidelines in 2011 (24%) vs only 6% in 2009. Documentation in notes; improved to 12% with one event and 55% with ≥4 events compared to 3% and 13% respectively 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: Improvements in reassessment and documentation were noted and the benefits reflected by the fewer number of recurrent hypos. Further education of the staff to use the hypoboxes appropriately and guidelines to proactively decrease the incidence of hypoglycaemia are planned.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.