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:
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.