Endocrine Abstracts

Introduction: Hyperosmolar Hyperglycemic State (HHS) is an uncommon and potentially fatal complication of diabetes. HHS is a medical emergency with high mortality. Therefore, it needs to be managed promptly and carefully utilising nationally agreed guidance. Delays in recognition and challenges in management may lead to poor outcome.

Aim and Targets: The primary objective is to improve the recognition and management of HHS. The project was set to the standards of the HHS guideline produced by the Joint British Diabetes Societies (JBDS) in August 2012. Our target is to improve adherence with this national guidance by at least 50% by May 2022.

The Project: A retrospective audit was undertaken initially to understand the current local care of patients admitted with HHS. this was conducted in a single district general hospital. Data were collected from the medical notes of patients with a diagnosis coded as “Hyperosmolar Hyperglycemic State/HHS” in the proceeding 12 months. The data clearly demonstrated that the current local practice falls short of the JBDS recommendation for HHS. This spanned from identification to management (rehydration, insulin therapy and monitoring) of HHS.

Intervention: A number of interventions to increase awareness and improve the management of patients admitted with HHS were applied simultaneously. In addition to teaching sessions for clinicians working in acute medical admission wards, an HHS prescription chart was introduced with details about the diagnostic criteria and further management of HHS and possible metabolic complications based on the JBDS guideline. This was structured in an easy step by step approach.

Discussion and conclusion: HHS is an uncommon medical emergency and sometimes it’s the first presentation of Type 2 diabetes. Moreover, it usually co-presents with other medical conditions (infections, vascular events etc) which makes the recognition more challenging. A second audit to gauge the degree of improvement the interventions contributed to the care of patients with HHS is currently being prepared. This will contribute to further interventions to the already established prescription charts and education sessions as deemed required. This project provides a useful learning opportunity for quality improvement and patient safety contributing to better patient care.