ECE2018 Poster Presentations: Diabetes, Obesity and Metabolism Diabetes complications (72 abstracts)
Knowledge and Attitudes of Trainee Doctors in the Management of DKA and Compliance with current Protocol in a large University Teaching Hospital
Carmel Kennedy 1 , Tara McDonnell 1 , Kennedy Cormac 2 , Salmaan Bholah 1 , Valerie Julius 1 , Agnieszka Pazderska 1 , Marie Louise Healy 1 & Niamh Phelan 1
1Endocrinology Department, St James’ Hospital, Dublin, Ireland; 2Pharmacology Department, St James’ Hospital, Dublin, Ireland.
Diabetic Ketoacidosis (DKA) is a diabetic emergency with associated morbidity and mortality. Current evidence supports a protocol-based approach to its management. Our survey was conducted in a tertiary university hospital, where patients with DKA are initially managed as part of unselected general medical take.
Objectives: To assess knowledge and confidence of trainee doctors in DKA management. To review adherence to DKA protocol and identify areas for future intervention and improvement.
Methods: Using diabetes consultation records, we identified 30 patients admitted with DKA to our hospital between October 2016 and October 2017. We audited adherence to the current DKA protocol. Concurrently, a survey was circulated to medical trainees to identify knowledge and attitudes towards DKA.
Results: Suboptimal compliance with DKA protocol was identified with respect to fluid resuscitation and adequate monitoring of potassium, with subsequent development of hypokalemia in eight patients. 33.33% of patients developed hypoglycaemia during intravenous insulin infusion, most commonly due to delayed cessation of fixed, weight-based doses of insulin infusion once ketonemia had resolved. 55 (29%) of medical trainees working in the hospital responded to our survey. 60% of respondees demonstrated poor knowledge of appropriate fluid resuscitation. 75% reported that checking potassium at the advised intervals was only achievable on wards where nursing staff perform phlebotomy. Only 45% of those surveyed recognised the need to switch to variable rate insulin when DKA resolved. Only 20% expressed confidence in performing the switch from IV to subcutaneous insulin.
Discussion: Fidelity to DKA protocols is often poor. Prior research on interventions to improve compliance is primarily from the ICU setting. We show that deviations mirror areas where physicians lack confidence. A multifactorial educational intervention has been proven to be effective at improving guideline compliance in DKA.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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