Background:

In August 2014 the NSW Subcutaneous Insulin Prescribing Chart was introduced to Liverpool Hospital. At the time a comprehensive educational program was undertaken, targeting Nursing and Medical staff.

Aim:

To determine if the implementation of the insulin chart was effective in improving inpatient glycaemia and safety.

Method:

Retrospective data was obtained from the Incident Information Management System (IIMS) involving insulin, 2 months prior and 2 months post-implementation of the chart. A qualitative review was attended.

Quantitative data was analysed, by conducting an audit assessing capillary blood glucose levels 1 month prior and 2 – 3 months post insulin chart implementation.

Results:

IIMS data revealed an increase in incidents involving insulin. A total of 10 incidents were retrieved, 3 incidents pre-implementation (June -July 2014) and 7 incidents post-implementation of the chart (September – October 2014).

Pre-implementation of the insulin chart a total of 992 capillary blood glucose results were reviewed from patients treated with subcutaneous insulin; the rate of hypoglycaemia was 3.5% (BGL< 4.0mmol/L). Post-implementation of the chart a total of 738 blood glucose results were captured, and the rate of hypoglycaemia was 2.7% (BGL< 4.0mmol/L).  The proportion of glucose level above 10mmol/L was significantly lower following implementation of the new chart (42.0% vs 54.1%, p<0.001).  Comparative analysis will be presented during the meeting.

 Conclusion:

Most insulin charts were used and charted correctly. The new subcutaneous insulin chart did not reduce the presentation of incidents involving insulin errors.  However, inpatient glycaemic control was better, with a smaller proportion of glucose readings above 10mmol/L.   Nevertheless, the number of glucose levels above the target range was still higher than what was recommended by Australian Diabetes Society guidelines. We believe further mandatory training to junior medical officers and nursing staff tailored to their needs will further improve in-patient glycaemic control.