Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care

Jones, G. C., Perry, C. G., Monaghan, A., Kennon, B. and Sainsbury, C. A.R. (2015) Capillary blood glucose monitoring, inpatient hypoglycaemia and quality of care. British Journal of Diabetes, 15(1), pp. 24-26. (doi: 10.15277/bjdvd.2014.041)

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Aims: Hypoglycaemia confers excess morbidity and mortality. UK guidelines recommend capillary blood glucose (CBG) measurement is repeated 15 minutes following identification and treatment of CBG <4mmol/l. We assessed adherence to this guidance, influence of initial CBG on time to repeat (TTR), and the impact of a quality improvement intervention on TTR. Methods: We identified CBG readings (Abbott-PrecisionWeb) of 18,118 inpatients with recorded hypoglycaemic CBG between January 2009 and September 2013. TTR and associations with initial CBG were investigated. A single ward was targeted with an intervention (National Health Service Scotland Quality Improvement Hub ThinkGlucose pilot) during 2012. TTR was identified and compared before, during and after intervention. Results: Of 90,935 CBGs <4mmol/l, 4.4% had no recorded repeat CBG. Of the 83,484 repeated CBGs, median TTR was 80 minutes, with 8.9% repeated within 15 minutes and only 42.2% within 60 minutes. TTR was proportional to initial CBG with median 22 minutes (IQR 10-47) for initial CBG 1-1.9 mmol/l, median 48 minutes (IQR 24-104) for 2-2.9 mmol/l, median 112 minutes (IQR 52-309) for 3-3.9 mmol/l(p=0.05). On the vascular unit, TTR improved post intervention from a median 77 minutes (IQR 37-281, n=843) to 29 minutes (IQR 19-55, n = 1041), and improvement persisted with median 20 minutes (IQR 15-28, n=268) in the nine months after the project ended. Conclusions: TTR is a marker of treatment quality in hypoglycaemia and is suboptimal. TTR reduces with worsening initial degree of hypoglycaemia. We have shown a quality improvement package can produce sustained reduction of TTR.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Sainsbury, Dr Christoper and Kennon, Professor Brian and Perry, Dr Colin and Jones, Dr Gregory
Authors: Jones, G. C., Perry, C. G., Monaghan, A., Kennon, B., and Sainsbury, C. A.R.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:British Journal of Diabetes
Publisher:Association of British Clinical Diabetologists
ISSN (Online):2397-6241

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