A six week ambulatory insulin phone titration program at a tertiary hospital — ASN Events
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A six week ambulatory insulin phone titration program at a tertiary hospital (#391)

Margaret Loh 1 , Elizabeth Mulrooney 1 , Theresa Amoore 1 , Charlotte Hurburgh 1 , Lisa Iulianetti 1 , Kathleen Steele 1
  1. Department of Endocrinology and Diabetes, St Vincent's Hospital, Fitzroy, VIC, Australia

Aim: To investigate whether an Ambulatory Insulin Phone Titration Program at a tertiary hospital is effective in achieving patients’ glycaemic targets within the intended six week timeframe.

Background: Our tertiary hospital has an Ambulatory Insulin Phone Titration Program available to patients’ who attend Diabetes Outpatient clinics or have been Inpatients requiring Endocrine Specialist care. Patients’ are referred by a doctor who completes the ‘Ambulatory Insulin Stabilisation Referral Form’ based on 2004 ADEA Ambulatory Stabilisation recommendations. Criteria for enrolment includes phone access, English speaking patient or family willing to phone weekly, knowledge of insulin action, injection technique and hypoglycaemia management and prevention.  Patients’ phone the Credentialed Diabetes Nurse Educator (CDNE) weekly to report blood glucose (BG) results and receive titration advice.

Method: Audit of patients’ phone titration records (n=154) enrolled into the program over 12 months (February 2014 – February 2015). Data were collected on individualised glycaemic targets and BG results from date of enrolment to completion of the program (six weeks).

Results: The table shows audit data for 67 patients’(43.2%) who participated in the program.

 

 

Yes

No

Unknown

Glycaemic targets met within 6 weeks

26.9%

43.3%

29.8%

 

Discussion: There were limitations in assessing effectiveness of the program. Whilst 154 patients were enrolled in the program, 87 patients (56.5%)  failed to initiate any phone calls with CDNE for insulin titration advice. 46 referral forms (29.8%) did not have BG target range documented on the form. Therefore, it was not possible to assess if BG targets were met.

On average, 20 minutes is spent on each call and documentation. If all enrolled patients called weekly, 51.3 hours /week of CDNE time would be required; more than one full-time position.

Conclusion:The Ambulatory Insulin Phone Titration Program was effective in achieving glycaemic targets in almost one-third of participating patients. Further research into barriers preventing patients’ from achieving glycaemic targets and why patients’ failed to call for titration advice needs to be investigated.