1. Scottish Patient Safety Program Glycaemic Control Monklands ITU

2. Aims Blood Glucose Range 3.5 – 8.5 mmol/l 80% of measurements within target range Avoid hypoglycaemia - <3.5mmol/l Recently changed target glucose range 4.4 – 10.0 mmol/l

4. Tools DISEASE US PATIENTS Raw data Data display ANNOTATIONS Allowed hypotheses to be made Our System

5. Example…

6. Over Time…

7. MONKLANDS HAIRMYRES WISHAW

8. What did we do? - 3 Phases 1.A Better Protocol Management of insulin and feed Frequency of monitoring Dosing of insulin Steroids by infusion rather than bolus At this stage, we avoided different protocols for different patients.

9. What did we do? - 3 Phases 1.A Better Protocol 2.Follow the Protocol Long process of discussion with staff How do you keep control of blood glucose? Segment 1.Experience vs non experience 2.Busy unit

10. What did we do? - 3 Phases 1.A Better Protocol 2.Follow the Protocol 3.Redundancy – June 2009 Safety Briefings at morning handover Importance of glycaemic control reiterated and latest compliance figures pointed out to staff – FEEDBACK Nurses put in pairs – more senior with more junior to help with management of blood glucose– spread the experience DISEASE US PATIENTS PROCESSSTRUCTURE

11. Now… Hypoglycaemia rate 0.43%

12. So What? Compliance increased from 74% to 82% – Important? – For how long? Lessons – Change is possible but may not be quick – many useful changes – We can apply this method – what next? – The system fails to use staffs’ abilities – Work together – Telling people to do things differently is not enough – measure, investigate – Steal Ideas!