Endocrine Abstracts

Background: The Covid-19 pandemic has led to various unprecedented challenges and obstacles, especially in the field of Diabetes and Metabolism, many of which are as novel as the pandemic itself. Discovering efficacious therapeutic options resulting in positive outcomes has been a challenge. Dexamethasone has been shown to reduce mortality in patients with Covid-19 pneumonitis who require oxygen therapy and/or ventilation. Exogenous steroid therapy is renowned to cause adverse metabolic side effects, including Hyperglycemia. In addition to this, concurrent Covid-19 infection further exacerbates the issue at hand.

Aims: The main aim of the Quality Improvement Project (QIP) was to improve adherence and compliance of capillary blood glucose (CBG) monitoring in patients with Covid-19 pneumonitis treated with steroid therapy by implementation of educational tools. Our results were compared with the standard of care guidance as set out by the Joint British Diabetes Societies (JBDS) Specific emphasis was placed upon early recognition of Hyperglycaemia, leading to improved Glycaemic control and patient outcomes.

Methods: Phase one of the project involved data collection on a retrospective basis of patients admitted to both the medical and COVID wards. This involved obtaining relevant information from the patient’s medical, nursing, and electronic notes. Changes were implemented in the form of teaching and educational sessions for the nursing staff. Posters focusing on the important of Blood Glucose monitoring were circulated on the medical wards including the COVID wards. This was followed by discussions emphasising the importance of Blood Glucose monitoring on the board rounds.

Results: Data collection prior to changes showed that out of the cohort of 23 patients, only 5 patients (21.74 %) met the desired standard of care as per the guidance set out by the JBDS. Following implementation of changes, data collection revealed an improvement of compliance from 21.74 % to 56.52 %. Out of 23 patients, the desired level of care was now met in 10 of the patients. The project was carried out over a period of 3 months, commencing in October 2020, and concluded in January 2021

Conclsions: Hyperglycaemia was associated with worse outcomes. Our QIP improved rates of blood glucose monitoring, followed by early recognition of hyperglycaemic states. This was also reflected in the fact that early recognition led to early therapeutic measures and prevention of diabetic emergencies. Despite significant changes, we aim to instigate further improvement by reinforcing learning among the frontline staff to achieve 100% compliance with the guidelines.