Hypoglycaemia Management of Adult Inpatients with Diabetes — ASN Events
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Hypoglycaemia Management of Adult Inpatients with Diabetes (#26)

Brett Fenton 1 , Julie Droguett 1 , Jennie King 1 , Leah Snape 1 , Christine Thompson 1 , Tracy Desborough 1 , Belinda Vernon
  1. Central Coast Local Health District, Gosford, NSW, Australia

Background: Patients with diabetes requiring insulin and/or sulfonylurea medication are at risk of hypoglycaemia. For each day with hypoglycaemia, patients’ length of stay is increased by up to 2.5 days1 and the risk of inpatient mortality is increased significantly2.  Hypoglycaemia incidents and anecdotal feedback from staff and patients of hypoglycaemia management that did not match the local procedure, identified a need for investigation and change.

Aim: The aim of this audit was to determine the frequency of hypoglycaemia events in at risk patients and the appropriateness of hypoglycaemia treatment and management.

Methods: In April 2013, an audit of bed charts and medical records of patients at risk of hypoglycaemia was conducted in the medical and surgical wards at Gosford and Wyong Hospitals.

Results: There were 489 inpatients on the designated audit days. 89 patients (18%) had a diagnosis of diabetes, of which 58% (52) were prescribed insulin and/or sulfonylurea medication.  Data related to all hypoglycaemia episodes was collected retrospectively for the patients’ length of stay. Of 52 patients at risk of hypoglycaemia, 29 (56%) experienced a total of 205 recorded hypoglycaemic episodes. Fifteen episodes (7.4%) were severe (BGL < 2.0 mmol/L).  69 (34%) episodes had no documented treatment. Alarming, in only 18/205 episodes (8.7%) were patients retested within 15 minutes as per local guidelines. The average time to re-check BGLs was 116 minutes. Results indicate a knowledge deficit regarding best practice care of patients with diabetes at risk of hypoglycaemia, in particular the safe use of insulin and hypoglycaemia detection and management.

Implications: The following ten recommendations were made to Hospital executive based on the results: Review of the hypoglycaemia procedure; mandatory education; development of diabetes education package for clinical staff; recognition of at risk patients on admission; hypoglycaemia kits on all wards; monthly review of hypoglycaemia related incidents; Diabetes working Party; business case for expert Diabetes nurse within the acute setting.

Conclusion: This project highlighted significant changes required to improve inpatient diabetes management. Re-audit is planned in 2016 to evaluate recommendations implemented.

  1. Turchin et al (2009) Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care 32(7): 1153–1157.
  2. Nirantharakumar et al (2012) Hypoglycaemia is associated with increased length of stay and mortality in people with diabetes who are hospitalized. Diabetic Medicine, 29: e445–e448.