Endocrine Abstracts

Confidence of Emergency Department (ED) Clinicians in the management of Paediatric Type 1 Diabetic (T1DM) Emergencies was investigated at Wythenshawe Hospital to gain an understanding of future training needs. A questionnaire assessing the overall confidence of ED clinicians in the recognition and management of Diabetic Ketoacidosis (DKA), management of children with insulin pump therapy and use of the BSPED sick day rules was circulated. Previous training on this topic in the last 12 months, which areas they required more training, and how this should be delivered was also assessed. Furthermore, an educational session about insulin pump therapy and the sick day rules was delivered to 5 ED registrars and understanding was assessed with a pre- and post-session clinical scenario quiz. In total 27 clinicians completed the questionnaire, 70.4% were doctors, 25.9% nurses and 3.7% were ACPs. Experience in ED ranged from 2 months to 25 years. 18.5% of respondents reported no confidence with the management of paediatric T1DM emergencies, 7.4% responded slightly confident, 37% moderately confident and 37% very confident. 77.8% were either confident or very confident with recognition and initiation of treatment for DKA. However, 51.8% either had no or very little confidence with managing children on insulin pumps in ED and 51.9% were not aware of the sick day rules. Two thirds of respondents were not confident managing a patient presenting to ED with high blood glucose and ketones with a normal blood gas. 88.9% had not received training on management of paediatric T1DM emergencies in the last year. Topics requiring further training included the sick day rules, initiating treatment for DKA, managing hypoglycaemia and communication with the diabetes team, and most would prefer these as in-person workshops or simulation training. After the teaching session the results of the quiz improved with 4 out of 5 achieving 75% in comparison to the previous highest pre-session score of 50%. These results have led to the implication of an educational programme from the Paediatric Diabetes team to the clinicians in ED in order to improve the clear lack of confidence of ED staff in managing paediatric T1DM emergencies.