Endocrine Abstracts

Background: Cranial Diabetes Insipidus (CDI) or Arginine-Vasopressin Deficiency (AVP-D) is a potentially life-threatening condition requiring treatment with desmopressin. Omission or delay in desmopressin can result in serious patient harm.

Aims: Evaluation of desmopressin prescription/administration practice and implementation of an action plan to improve patient safety.

Methods: Retrospective review of electronic case notes of patients with CDI/AVP-D admitted to Sheffield Teaching Hospitals between 2018-2021 was performed. The outcomes were defined as: total number of missed and delayed doses, time to prescription and administration from admission, and incidence of dysnatraemias.

Results: Total 102 admissions from 46 patients were identified with median [IQR] age of 60.7 [38.5-70.8] years (females=55.8%). 38% of the admissions were via emergency department (ED). Total number of missed and delayed doses were 132/1315 (10.0%) and 139/1283 (10.9%) respectively. 33% of admissions had ≥1 missed doses while ≥1 doses were delayed in 54% of admissions. Reason was documented for 43.2% of missed and 15.8% of delayed doses. Most common reasons were medication unavailability, patient’s inability to take medication, and clinical reasons to omit dose. Median [IQR] prescription and administration time from admission was 5.6 [2.7-10.7] and 15.1 [8.7-27.0] h, respectively. The incidence of hypernatraemia was 7.6% and hyponatraemia was 30.4%. ED rates of desmopressin prescription were low at 5%.

Based on these findings following steps have been implemented:

1. Desmopressin is listed and stocked as critical drug in all areas.

2. Development of local registry.

3. Electronic notes and prescription alerts with reminders to contact endocrinology.

4. Qualitative staff surveys to determine knowledge baseline.

5. Development of tailored education package.

Conclusion: Desmopressin prescription and administration delays are common and pose patient safety risk. Point of ED was found to have the lowest rate of prescription and education package is planned. Re-audit is required to evaluate these interventions.