Authors (including presenting author) :
LEUNG SM
Affiliation :
Centre for Diabetes Education and Management, Our Lady of Maryknoll Hospital
Introduction :
A 2-week retrospective Case Review was conducted from 5 Aug to 18 Aug 2019. Total number of patients with diabetes admitted during the period was 80. Male 48 (60%), aged ranging from 42 to 94. Total 21 hypoglycemic episodes detected in 13 (16%) patients.
Objectives :
To assess the staff adherence of applying the “Management Algorithm of Hypoglycemia in Patients with Diabetes”. In addition, by using the audit findings to consolidate the current clinical practices; evaluate the treatment adherence of nursing care on hypoglycemic management; and eventually identify the strengths and weaknesses, and potential areas for improvement.
Methodology :
The results of this audit report reflected that poor adherence was noted in hypoglycemic management, monitoring and documentation. The reasons of non-adherence may be related to knowledge deficit and not familiar with the correct pathway of getting related information. These identified areas can be improved through continuous in-service training and periodic audit. Diabetes link nurses are empowered to deliver the message to other colleagues through train-the-trainer principle. Besides, regular in-service training can also enhance colleagues’ adherence on hypoglycemic management protocol. In addition, cue card printed with practical tips for hypoglycemic management is designed to improve the accessibility for colleagues to retrieve this information. Periodic audits will be arranged to maintain the sustainability of hypoglycemic management and quality of care for patient with diabetes.
Result & Outcome :
The main goal of this program is to improve the management of hypoglycemia for patients with diabetes. The “Management Algorithm of Hypoglycemia in Patients with Diabetes Audit Checklist” was used to measure hypoglyccemic treatment and monitoring practice. The checklist consists of two parts. The first part assesses the appropriateness of hypoglycemic management for both “conscious & alert patients” or “unconscious patients”. The other part assessed whether the progress document recorded correctly. For patient with hypo attack, nursing colleagues delivered correct and prompt treatment of giving 15 gm simple sugar which account for only 38.1% adherence. The reason of non-adherence including giving milk supplement, snacks and glucose water with unknown content instead. Around 57% of them, post-hypoglycemic attack monitoring (recheck h’stix after 15mins) was properly delivered, whereas 14.3% and 9.5% rechecked h’stix after 20mins and 30mins respectively. After simple sugar treatment, only 4.8% of them could deliver 15 gm carbohydrate content food when h’stix return to normal (≥ 4mmol/L). Besides, only 23.8% of the documentation clearly described the management process.
