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

People with diabetes

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

Patients with diabetes on the WGH site

Hypoglycaemia management

Time of hypoglycaemia 3756 episodes in a 12 month period

Outcome of improved hypoglycaemia management 20 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

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

NHS Lothian Need to look at the 4 week results WGH

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

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

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.  

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

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)

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