P88 Recognition and management of hyperglycaemia at the front door: A retrospective audit and QI project conducted in Accident and Emergency (A&E) and Acute Medicine Unit (AMU) of a large district general hospital

Published Date: 23rd March 2022

Publication Authors: Cho S

Background
Hyperglycaemia frequently occurs in acutely unwell patients and its improper recognition and treatment leads to undesirable consequences, including diabetic emergencies and impaired recovery. Morbidity and mortality for this group can be improved through early disease detection and treatment modification, and the acute admission window represents an important opportunity to achieve these outcomes.

Methods
We conducted an audit to investigate compliance with inpatient diabetes guidelines across our Trust’s A&E and AMU. 2 cycles of retrospective audit were completed following an intervening QI intervention. Causes and contributing factors for hyperglycaemia were fully identified, actions and responses by staff were analysed against the standard of our Trust guidelines, and an educational initiative was formulated and implemented aimed at acute medical and nursing staff. Patients with DKA or HHS were excluded as these patients are intensively monitored by virtue of their diagnoses.

Results
34 and 39 patients were included in each cycle respectively. Re-audit following intervention demonstrated significant improvements across the following outcomes over this timescale: inpatient glucose and ketone monitoring of hyperglycaemic patients, appropriate prescription of critical diabetes medications on admission, and documentation and recognition of hyperglycaemia on the acute medical post-take ward round. Referral to the inpatient diabetes team occurred in 100% of cases after post-intervention.

Conclusion
We demonstrate that an educational initiative can lead to a substantial improvement in management of hyperglycaemia in the acute setting. We intend to ensure these improvements are maintained through production of further infographic-type poster materials and through feedback of good practice to staff.

 

Sharma, A; Cho, S. (2022). P88 Recognition and management of hyperglycaemia at the front door: A retrospective audit and QI project conducted in Accident and Emergency (A&E) and Acute Medicine Unit (AMU) of a large district general hospital. Diabetic Medicine. 39 (Suppl 1), 65

 

 

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