Hypoglycaemia is a barrier to optimising inpatient glycaemic control. A prior audit of hypoglycaemia at our hospital found that patients with congestive cardiac failure(CCF) were particularly vulnerable to hypoglycaemia during their hospital admission, and that glycaemic therapy was sometimes not always adjusted appropriately. There is extensive evidence that diabetes educator led case review can improve hospital related glycaemic outcomes. We therefore designed an intervention for the cardiology ward. The aim was to determine whether case review with ward staff was able to affect the rate of hypoglycaemia on the cardiology ward.
Method
Human Research Ethics Committee has been acknowledged of this quality assurance activity. A Credentialled Diabetes Educator(CDE) was notified of any cases of hypoglycaemia with PACE(Patient with Acute Condition for Escalation) call had been made. After review of glycaemia, a discussion of glycaemic management was undertaken with medical and nursing staff caring for the patient and CDE provided patient education if appropriate. The duration of this audit is from February 2016 to April 2017.
Results
In total, 29 patients have 30 PACE calls over 15 months. The female to male ratio is 10:19. The age range is 61-87 year and the mean age is 76 year. The reasons for admission include: CCF--38%, Acute Coronary Syndrome(ACS)--17%, supraventricular tachycardia(SVT)--10%, hyperglycaemia--7% and others (aortic stenosis, chest pain, hypertensive crisis etc.)--28%. The quarterly trend for PACE calls directly related to hypoglycaemia is declining from 12 to 0 patients over the 15 month period audited.
Conclusion
Case based staff education can lead to improved glycaemic outcomes. This result is in keeping with utility of diabetes ward liaison staff to provide specialised support to ward staff in glycaemic management. Reduction in hypoglycaemia may also reflect a reduction in use of sulfonylureas and dosage of insulin, medical & nursing staff awareness of treatment for people with diabetes.