The project undertaken by the inpatient diabetes team at Bedford Hospital aimed to reduce the number of adult inpatients experiencing hypoglycaemic events. The initiative was devised following poor results at local and national audits.
The baseline knowledge of healthcare professionals at Bedford Hospital was poor, and documentation of blood glucose readings and action on hypoglycaemia events was inadequate. The project consisted of specific training schemes for ward nurses, junior doctors and senior doctors, along with gaining support from senior hospital management, monthly audits with individual feedback and a total redesign of the blood glucose documentation chart. A 50 per cent reduction in hypoglycaemic events and a 60 per cent reduction in recurrent hypoglycaemic events was achieved as well as a marked improvement in patient experience and staff knowledge on the most recent National Diabetes Inpatient Audit (2011).
Bedford Hospital is a small/medium size Acute Trust with a high proportion of inpatients with diabetes, 50 per cent of who are treated with insulin. The majority of adult inpatients with diabetes are admitted with conditions other than their diabetes and are looked after by non-diabetes specialists.
The inpatient diabetes team (covering other patients than its own) comprised one diabetes specialist nurse, a diabetes specialist pharmacist and less than one session of consultant diabetologist time per week.
In 2010 the SpR in diabetes undertook two hospital-wide audits to document the rates of hypoglycaemia among adult inpatients with diabetes. This followed some poor results in the 2009 National Diabetes Inpatient Audit and a couple of serious incidents where hypoglycaemia may have contributed to patients’ deaths. The audit revealed that 37 of 91 patients (41 per cent) had at least one hypoglycaemic event in the preceding 48 hours and many of these patients had recurrent episodes of hypoglycaemia over the following 48-hour period. The result was confirmed in the National Diabetes Inpatient Audit 2010 when 32.7 per cent of diabetes inpatients had a mild hypoglycaemic episode (compared to 22.6 per cent nationally).
The hospital has had Trust-wide guidelines for the management of hypoglycaemia since 2005 and ward hypo boxes since 2009 but these were not being used properly. The team at Bedford Hospital therefore decided to develop a project to reduce the rates of hypoglycaemia and recurrent hypoglycaemia among adult inpatients with diabetes by 30 per cent and to improve the treatment of hypoglycaemia when it occurred.
To reduce the rates of hypoglycaemia and recurrent hypoglycaemia among adult inpatients with diabetes by 30 per cent over one year and to improve the treatment of hypoglycaemia when it occurred.
The outcome measurement was three, monthly hospital-wide audits and the National Diabetes Inpatient Audit 2011. The project was also the subject of a CQUIN.
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