Background - The New South Wales Adult subcutaneous insulin prescribing (ASCI) chart was introduced into NSW hospitals in January 2014. Developed by the Agency of Clinical Innovation, it combines subcutaneous insulin prescription and administration, with blood glucose, ketone monitoring and glycaemic management guidelines. The ASCI chart was implemented at the John Hunter Hospital (JHH) on 12th May 2014. Prior to the implementation of the ASCI chart, subcutaneous insulin was prescribed on the regular Adult Inpatient Medication Chart with blood glucose levels recorded either on the SAGO chart or a separate glucose monitoring chart. The objective of this retrospective audit was to review the effect of the ASCI chart on inpatient glycaemic management.
Method: Medical records of all inpatients admitted to JHH on 12th November 2013 (6 months prior to implementation) were manually reviewed and the collated data compared with inpatients admitted on 12th November 2014 (6 months post-implementation). Main outcome measures were responses to blood glucose levels out of target and Insulin charting errors.
Results- There were 499 inpatients (aged >18) admitted in the John Hunter Hospital on 12 November 2013. Of these patients, 22.4% (n=112) were known diabetics. In comparison there were 523 inpatients on 12 November 2014 of which 23.3%(122/523) were diabetics. Out of 122 Diabetics only 74 patients had active ASCI charts.
With the commencement of ASCI chart, insulin error rates reduced from 20.9% to 5%. BGLs above 10mmol/L resulted in action in only 14% of cases in 2013 compared to 28.1% in 2014. BGLS below 4mmol/L resulted in action in 45% of cases in 2013 compared to 100% of cases in 2014.
Conclusion: Implementation of the NSW Adult Subcutaneous insulin chart at John Hunter Hospital resulted in a significant improvement in glycaemic management. However better ASCI chart utilisation is needed.