Endocrine Abstracts

Background: Hypoglycaemia is a common and potentially life-threatening complication in hospitalised patients with diabetes with increased risk of neurological injury, cardiac arrhythmias, prolonged hospital stay and increased mortality. Initial audit identified failure to comply with trust guidelines, inconsistent documentation and inappropriate aftercare in patients who experienced inpatient hypoglycaemia.

Aims: This quality improvement project aimed to improve compliance with hospital hypoglycaemia guidelines to 70% in 3 months with the secondary objective of increasing adherence to electronic hypoglycaemia proforma created as an intervention to 50%.

Methodology: A baseline audit was conducted with 31 inpatients with hypoglycaemia across medical wards in the County Hospital, Stafford. Key standards assessed included appropriate treatment according to consciousness level, documentation, repeat glucose monitoring and approriate aftercare. Interventions were implemented using Plan–Do–Study–Act (PDSA) cycles, including introduction of an electronic hypoglycaemia management proforma, educational video on the trust intranet, targeted teaching sessions of reminder posters in clinical areas. A re-audit was performed with 37 patients 3 months after implementation to assess impact.

Results: The baseline audit demonstrated suboptimal compliance with trust guidelines, e.g. IV glucose bolus given in 50% patients in unresolved hypoglycaemia in conscious/semiconscious patients who are able to swallow and omitting the next due dose of insuline in 51% of the cases. The overall compliance with the trust guidelines was 33%. Following the interventions, compliance improved significantly to 86% where the new electronic proforma was used and 44% where it was not used. Statistical analysis using Fisher’s exact test demonstrated a significant improvement in guideline adherence (P = 0.016, 95% confidence interval).

Conclusion: This project demonstrated that simple, low-cost interventions can significantly improve the management of hypoglycaemia in the hospital setting. Sustaining these improvements will require continued education, incorporation of guidelines into staff induction, and ongoing audit cycles to ensure patient safety and high-quality care.