1. Bedside point of care glucose testing for improving inpatient care
Dr Stuart Ritchie Consultant Physician, NHS Lothian
Medical lead, Diabetes Think Check Act programme

2. People with diabetes

3. Outline Relevant to all clinical areas in the WGH
Small changes to what we currently do can result in wider gain
Point of care glucose testing
Hypoglycaemia management
Pre bed snacks for appropriate treatments

4. Patients with diabetes on the WGH site

7. Hypoglycaemia management

8. Time of hypoglycaemia 3756 episodes in a 12 month period

9. Outcome of improved hypoglycaemia management20 40 60 80
100
06/02/2012
27/02/2012
19/03/2012
09/04/2012
30/04/2012
21/05/2012
11/06/2012
02/07/2012
23/07/2012
13/08/2012
03/09/2012
24/09/2012
15/10/2012
05/11/2012
26/11/2012
17/12/2012
07/01/2013
28/01/2013
18/02/2013
11/03/2013
Percentage of Hypo Episodes
Correctly treated
% of Patients Appropriately Managed
Median Line
Linear (% of Patients Appropriately Managed)
Introduction of
Hypo Boxes in
NHSGGC
Continuous Tests of
Change introduced
Motivated charge nurse
Acknowledgement: Dr Chris Sainsbury NHS GG&C

10. Economic analysis
The following assumptions were made based on the findings in the Diabetes- think, check, act test sites and from existing literature:
Incidence of Hypoglycaemic Episodes can be reduced by 20% and that this leads to a length of stay (LoS) reduction of between 1 and 2.5 days.
Successful management of Hypoglycaemic Episode can be increased by 50% (within the test sites, this varied between 41%-59%) and this leads to a LoS of 1 day.
Its not all about hypoglycaemia management – patient experience and QOL
Acknowledgement: Dr Chris Sainsbury NHHS GG&C, Nils Michael, Economic Adviser, Scottish Government

11. NHS Lothian
Need to look at the 4 week results
WGH

12. Identification of patients with diabetes
Self ran, extended to safety huddles
Stickers – referral guidance
Magnets
Electronic identification difficult

13. 1. Getting the basics right 2. Insulin administration
3. Management of hypoglycaemia 4. Subcutaneous insulin
5. Intravenous insulin 6. CPR for diabetic feet

15. Data linkage with SCI Diabetes
Inpatient Linkage is under development using SCI-Diabetes which receives admission, discharge and transfer (ADT) messages from the hospital Patient Administration System (PAS) so that it can identify exactly where a patient resides, at any stage during their inpatient stay. Patients are located on the system within a secure clinical ‘in-patient domain’ accessible by the specialist team. Further linkage with ‘connected’ blood glucose meters is providing blood glucose report and hypoglycaemia reporting in a pilot project in NHS Tayside. The aim is to form automated reports to populated inpatient care outcome reporting to demonstrate safety and quality.

16. Wish list?
Correct CHI and operator linkage to bedside capillary blood glucose
Highlight the education modules to those who want to know more
Patients on insulin and sulphonylureas get a CHO snack before bed
Improved management of hypoglycaemia
Remember the repeat blood glucose after 15 minutes

17. Some tests of change
Diabetes team huddle presence for same day discharge reviews
Diabetes team will offer 1 hour teaching per week in January / February (location flexible)

18. Summary Relevant to all clinical areas in the WGH
Keen to change from reactive to proactive
Small changes to what we currently do can result in wider gain
Point of care glucose testing
Hypoglycaemia management
Pre bed snacks for appropriate treatments