Endocrine Abstracts

Prompt, effective and safe management of Diabetic Ketoacidosis (DKA) is key to reducing mortality rate and length of stay. An Integrated care pathway (ICP) Pro-forma for DKA management during the first 24 hrs, based on a modified JBDS guideline was introduced in the trust. DKA management based on the pro-forma between Nov 17 to Feb 18 was audited; focussing on fluid management in terms of timing and electrolyte replacement, CBG monitoring, faster senior reviews, HDU admissions and other criteria assessed like checking HbA1c, post treatment insulin counselling and considering Psychological assessment. The audit data was compared to those done in 2007 and 2009–2010, when the pro-forma was not available. A sample size of N=5 was included in the audit for that period, with patients who did not fulfil all criteria for DKA being excluded.

Results: Showed all IV fluid administration meeting guidelines compared to 83% in 2010, 70% in 2007. Prescribing of Dextrose to cover potential Hypoglycemia was 100% compared to 90% in 2010 and 50% in 2007. All CBG monitoring met guidelines compared to 86% in 2010, 0% in 2007. No delay in assessments (>1 hour) compared to 20% in 2007 and no HDU admissions compared to 20% in 2010 and 2007. 80% received Insulin counseling, 20% had Psychological assessment considered but none had HbA1c checked during admission.

Conclusion: An overall improvement in meeting all clinical target areas was noted, highlighting the efficacy of introducing the ICP on improving care and safety. Areas needing improvement like HbA1c measurement was also noted. Aim is to re-Audit DKA management on a quarterly basis to sustain improvement.