Reducing inpatient hypoglycaemia

Alison MelvinLesley Cowley

Aims

• To improve appropriate treatment of hypoglycaemia as per Trust guideline – rapid acting carbohydrate eg lucozade followed by

complex carbohydrate if not prior to meal (ie before bed/during night)

• To reduce incidence of recurrent hypoglycaemia by 30%– Referral to inpatient Diabetes Specialist Nurse– Education to enable medical teams to manage dibates

more effectively

What did we do?

• Set up Think Glucose Oct 2010– Concentrating on insulin safety– Regularly reviewing hospital reported incidents

(containing word “Insulin”)– Realised that this was missing hypos– Re-designed insulin prescription chart which

incorporated CBGM – Ongoing ward based training around

hypoglycaemia

Money!!!!!

CQUIN hypoglycaemiaNumerator Part one – number of adult DM patients with

CBGM <4mmol/l whose hypoglycaemia management was consistent with local policy

Part two – number of adult DM patients who experience one or more hypoglycaemic events after 60 minutes of first reported episode

Denominator

£46,000 a quarter if achieved

Part one– number of DM patients who experience a hypoglycaemic event

Part two – the total number of patients with diabetes fitting the inclusion criteria

Problem!

• Resources • One part time consultant• One overworked DISN

• No more staff!

Making help from not much

• Encouraged some pharmacists to help us– Watching for insulin incidents– Part of Think Glucose team– Helping design new charts

• Link nurses to do some of the monthly audits and raise awareness on wards

• Involvement of senior management (Head of Nursing and matrons)

• Dietetic input

CQUIN - hypoglycaemia

Mar-11

Apr-11

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

0%

5%

10%

15%

20%

25%

30%

35%

40%

% of DM patients with hypos

% of patient with hypos

CQUIN Part 2 - % recurrent hypos

CQUIN part 1 - % correct management of hypos

Mar-11Apr-11May-11Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11Dec-110

5

10

15

20

25

30

35

total number of acceptable hypo Mx

total number of unacceptable hypo Mx

What has worked

• Persistence with message – much higher awareness in Trust

• Following up all incidents• Specific training for junior doctors, consultants,

individual training for nurses• Zero tolerance attitude from us• Praise wards which have done well in monthly audits• Feed back to ward/teams who have not done well• Institution of bedtime snack for all DM patients