Improving the quality of assessment and management of hypoglycaemia in hospitalised patients with diabetes mellitus by introducing 'hypo boxes' to general medical wards with a specialist interest in diabetes

摘要

Diabetes is becoming more prevalent in the UK and this is represented in the in-patient cohort, such that 1 in 6 hospital patients have diabetes\ud(1). The UK National Diabetes In-Patient Audit in 2012 estimated that 30% of patients experience one episode of hypoglycaemia during\udadmission. Hypoglycaemia is associated with increased morbidity and mortality, and longer length of hospital stay.\udIt is therefore important that hypoglycaemia is managed promptly and effectively to reduce associated morbidity. The Joint British Diabetes\udSociety recommends that all wards should have access to ‘Hypo Boxes’ (2).\udWe assessed all episodes of hypoglycaemia (<4.0 mmol/l) in the diabetes wards in over a 4 week period. ‘Hypo Boxes’ were installed to the\udwards and the appropriateness of treatment and time to correction of hypoglycaemia was re-assessed.\udAssessment of hypoglycaemia pre-intervention revealed 45 episodes of hypoglycaemia in 14 patients, and 42% (n=19) of episodes were\uddeemed to have been treated appropriately. Only 17.8% of episodes were corrected within 30 minutes, and 33.3% were corrected within 60\udminutes. A third of patients (35%) did not have a further blood glucose checked.\udFollowing intervention, there was a marked improvement in management. The proportion of appropriately managed episodes increased to\ud82% (n=35) and management of episodes of severe hypoglycaemia (<3.0 mmol/l) increased to 94%. The time to correction increased with\ud40% of episodes corrected to >4.0 mmol/l within 30 minutes, and a further 54% between 30-60 minutes.\udIn conclusion, the introduction of ‘Hypo Boxes’ improved the assessment and management of hypoglycaemia.