Background: The Australian Diabetes Society1 provides guidelines for effective inpatient diabetes management and recommends that routine blood glucose (BG) control in hospital should occur early and continue throughout the admission. BG monitoring is generally perceived to be invaluable to diabetes management in both inpatient and outpatient settings.
Aim: To investigated possible improvements in inpatient clinical care in patients who received BG monitoring early in the admission and then frequently throughout their hospital stay.
Method: A BG chart and guideline was developed and mandated for the inpatient setting. Face to face training was provided by a diabetes nurse educator who also provided ward based clinical support and guidance. An online training package was also made available. Four (4) case note audits (pre, 3, 9 and 19 months) assessed;
~ compliance with chart and protocol
~ identification and appropriate responses to hypoglycaemia and hyperglycaemia
~ impact on hospital length of stay
Survey evaluations were undertaken at staff training sessions and a series of staff interviews were conducted at 9 months.
Results: 261 case notes were audited in 3 rural hospitals over the 19 month period.
~ compliance with the chart achieved 90%
~ BG measurement within first hour of admission increased from 22% to 60%
~ compliance with 4 times/day BG monitoring achieved 90%
~ hypoglycaemia management by protocol was 100% when BG was recorded as per guideline.
~ identified 115 high risk inpatients with 22 being followed up via the diabetes rapid access service
~ an estimated 39 bed days saved.
Conclusion: Implementing a standardised and mandated BG chart and protocol has shown improvements in clinical and service response outcomes. In addition the clinical consultation input from the diabetes nurse educator for high risk inpatients and staff education resulted in greater compliance with the protocol and ultimately bed days saved.