Endocrine Abstracts

Introduction: Recently a serious incident due to failure in rechecking blood glucose (BG) after hypoglycaemia treatment was reported in an adult inpatient. We evaluated adherence to network guidance on hypoglycaemia management in inpatients and changes in practice following an intervention based on education and system changes.

Methods: In an audit (audit-1), hypoglycaemia episodes (BG level <4 mmol/l) were identified in paediatric inpatients (age <17 years) with diabetes mellitus receiving insulin from electronic patient records between May-July 2017. Hypoglycaemia management was evaluated by three parameters: identification of hypoglycaemia, appropriate treatment and rechecking after treatment. Subsequently, we implemented following recommendations: availability of wider range of oral hypoglycaemia treatments, hypoglycaemia treatment orders sets in electronic patient record linked to clinical guidelines and an education programme for ward nurses. The effects of these changes were evaluated by a second audit (audit-2) between January and July 2018.

Results: 21 hypoglycaemia episodes (Table 1) were identified in each audit [five patients with median age 10 (range, 1–16) years in audit-1; seven patients with median age 11.3 (2.3–16.5) years in audit-2]. A greater proportion (66.7% vs 14.3%; P=0.0054) of BG rechecking occurred within 30 minutes after treatment in audit-2 compared with audit-1.

Conclusion: This audit cycle demonstrated considerable improvement in rechecking BG after hypoglycaemia treatment which suggests effectiveness of the education programme and easier access to clinical guidance. However, these efforts need to be further intensified. We were unable to evaluate the appropriateness of treatment due to the large proportion of unrecorded treatments most likely due to self-administered treatments.