Endocrine Abstracts

Episodes of in-hospital hypoglycaemia are uncommon but serious events, which cost the NHS financially and cost the patient in terms of poor clinical outcomes, and rarely, mortality. The National Patient Safety Agency reported that in 2007, one in four adult diabetics experienced an episode of hypoglycaemia whilst in hospital. Moreover, one in 30 required i.v. glucose or i.m. glucagon therapy, and between 2003 and 2009 there were four deaths involving insulin overdose².

Part of the best practice in managing in-hospital hypoglycaemia is the use of hypo boxes, which are brightly coloured and easily recognisable for emergencies. The Joint British Diabetes Society produced guidelines on the hospital management of hypoglycaemia in adults in 2010, in which they recommend that all hospital trusts use hypo boxes. However, this audit has shown that doctors’ knowledge of where to find these hypo boxes is poor (initial audit results showed that only two out of 20 doctors (10%) knew where it was). Lack of knowledge of the hypo box location self-negates their existence, and poses a significant patient safety issue. Nonetheless, this audit has also shown that this deficit is easily corrected using a simple intervention like a teaching session (re-audit showed an improvement in knowledge from 10 to 95%).

On a more fundamental basis, this audit has demonstrated that new interventions, such as the introduction of a hypo box, are not easily welcomed into the clinical environment. In order for clinicians to change their current practice, reinforcement and encouragement are needed; otherwise these important interventions are at risk of being, quite simply, overlooked.