Endocrine Abstracts

Introduction: Point-of-care testing Ketone Monitoring (POCT KM) in the Emergency and Integrated Care setting is one of the most common investigations carried out, allowing for early recognition of life-threatening conditions such as Diabetic Ketoacidosis. Since its introduction, trust guidelines, which were established based on the recommendations by the National Institute for Health and Care Excellence (NICE), have been developed to assist with appropriate implementation of testing as well as indicate when to continue monitoring.

Objectives: Our study aimed to assess if POCT KM was carried out in adherence to trust guidelines; understand why the use of ketone was greater than anticipated; and address how to prevent incorrect monitoring.

Method: This retrospective study assessed adults on inpatient wards during April 2025, looking at their age, past medical history and indication for POCT KM based on the current guidelines found on the Intranet.

Results: This study concluded that of the 193 inpatients that were analysed, 61% (n = 119) of all POCT KM was not indicated according to guidelines.

Of these, the most common rationale for testing was:

• Capillary blood glucose CBG was >15 but the patient was not unwell/non-consecutive reading of >15 CBG (38%, n = 45). • Ketones are taken when CBG <15 (30%, n = 36). • Inappropriate continuance of ketone monitoring following initially correct rationale (11%, n = 13)

Conclusion: Unnecessary POCT KM contributes to ineffective use of staff time, increased patient anxiety from over-investigation, as well as a financial burden upon the Trust. This study concludes that the main intervention to help improve adherence to the guidelines would be focused teaching for nursing staff regarding when POCT KM is indicated, as well as for on-call staff surrounding hyperglycaemia management.