Endocrine Abstracts

Aim: To determine if inpatient hypoglycemia management in our trust is compliant with NICE guidelines and understand the conundrums in documentation and treatment of the hypoglycemic episodes.

Method: Retrospective audit on all patients admitted in Huddersfield Royal Infirmary who had hypoglycemic episode(s) in March 2021 which were picked up by wireless-enabled central capillary blood glucose monitoring system (cobas)¹.

Results: 62 episodes of hypoglycemia were recorded during the period with 48 episodes in patients with diabetes and 14 episodes in patients without diagnosis of diabetes. So, the 48 episodes were studied in detail. 35 (73%) of these hypoglycemic episodes were documented in EPR (Electronic Patient Record) of patients and the remaining 13 (27%) were only picked up by cobas¹. Of the 48 episodes, capillary blood glucose was checked on admission in 28 cases and in the remaining 20 cases, it wasn’t checked until more than 24hrs of admission. Management of only 4 patients (11%) was compliant with NICE guidelines where all the essential 4 steps were followed. The first step in management by treating with 15-20gms of carbohydrate in conscious patients and IV glucose/glucagon in unconscious patients is most followed step in 29 patients (83%). Only 8 patients (23%) had their capillary blood glucose rechecked in 15 minutes and the rest did not have any documentation of re-checking. Of the 35 documented episodes, only 7 patients (20%) received additional carbohydrates on recovery and 28 patients (80%) didn’t receive any additional carbohydrates according to the guidelines. 10 patients (29%) had continuing hypoglycaemia in 35-40 minutes and only 6 (60%) of them received intravenous treatment.

Conclusion: Results show that in only 4% of patients with hypoglycaemic episodes, all steps of hypoglycemia management were followed and this implies a significant scope in improvement in managing these patients. We are planning to arrange regular teaching for nursing staff on managing as well as documenting these episodes. Also, we are planning to include a “Hypoglycemia form” to fill in after each hypoglycemic episode in EPR which can further help in auditing future episodes (planned in 6 months) and aid in achieving better outcome.

1. Accu-Chek Inform II System (Roche) which connect with the COBAS POCT IT 1000 solution.