Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

Does training positively enhance staff perception and change in management of hyperglycaemia in the inpatient setting ? (#361)

Collette Hooper 1 , Michelle Penny 2 , David Jesudason 1 , Jane Giles 1
  1. Country Health SA, Country Health South Australia, Adelaide, SA, Australia
  2. Riverland General Hospital, Riverland, South Australia, Australia

Background: Historically, Country Health SA rural and remote (R&R) hospitals have used the approach referred to as Sliding Scale Insulin (SSI) as a means of managing blood glucose in the inpatient setting. Evidence based protocols that use a basal-bolus insulin (BBI) regimen have been shown to achieve better glucose control than stand-alone SSI.1,2,3,4,5,6,7 Subsequently, a BBI Protocol and Insulin Dosing Chart: Adult was developed and training to support the change in clinical practice offered.

Aim: To investigate if BBI training positively enhances staff perception and therefore facilitates change in management of hyperglycaemia in the inpatient setting in R&R hospitals.

Method: BBI training was delivered face to face and via videoconference. One such videoconference linked the presenting Endocrinologist with 12 R&R hospitals. Learning outcomes were identified and evaluations were available to complete.

Results: 44 health care professionals attended the multisite videoconference and included General Practitioners, Medical Students, Directors of Nursing, Clinical Service Cordinators, Pharmacists, Medication Safety Nurses and Diabetes Educators. 32 evaluations were received and 12 RACGP General Practitioner Feedback Forms were completed. The results identified:

  • the learning outcomes were met (entirely met in 91% )
  • the likelihood of the BBI Protocol and Dosing Chart: Adult being used is high (80%)
  • the change in clinical practice would be recommended to colleagues was supported (84%).

Since this videoconference, all 12 R&R hospitals have completed further staff face to face training sessions and nine sites have progressed to implementing this change in clinical practice.

Conclusion: Change in management of hyperglycaemia in the inpatient setting in R&R hospitals requires commitment from the local leadership group. Training provided to the multidisciplinary teams offered rationale and relevance to practice. The BBI training positively enhanced their perception that change in practice was warranted and change was subsequently, implemented. Ongoing monitoring and auditing will require attention from the local service leadership groups.

  1. Cheung, N and Chipps, D, 2010, Sliding scale insulin: Will the false idol finally fall?, Internal Medicine Journal, 40: p 662-4.
  2. Umpierrez, GE, Palacio, A, and Smiley, D, 2007, Sliding scale insulin use: Myth or insanity?, The American Journal of Medicine, 120: p 563-7.
  3. Umpierrez, G, Smiley, D, Jacobs, S, Peng, L, Temponi, A, Mulligan, P, Umpierrez, D, Newton, C, Olson, D, and Rizzo, M, 2011, Randomized study of basal bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 Surgery), Diabetes Care, 34(2): p 256-60.
  4. Australian Diabetes Society, 2012, Guidelines for routine glucose control in hospital, Australian Diabetes Society, Canberra
  5. Umpierrez, G, Smiley, D, Zisman, A, Prieto, L, Palacio, A, Ceron, M, Puig, A, and Mejia, R, 2007, Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial), Diabetes Care, 30(9): p 2181-6.
  6. Moghissi, ES, Korytkowski, MT, DiNardo, M, Einhorn, D, Hellman, R, Hirsch, IB, Inzucchi, E, Ismail-Beigi, F, Kirkham, S, and Umpierrez, GE, 2009, American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control, May/June 2009
  7. Roberts, GW, Aguilar-Loza, N, Esterman, A, Burt, MG, and Stranks, SN, 2012, Basal- bolus insulin versus sliding-scale insulin for inpatient glycaemic control: a clinical practice comparison, Medical Journal Australia, 196(4): p 266-9