Achieving 100% Reporting of Hypoglycemia in a Tertiary Care Hospital through a Structured Action Pathway & Persistent Monitoring Tool among Nurses

Hypoglycemia is a feared complication of management of diabetic patients, especially in critical care setting. Reporting and management of hypoglycaemia is an reflection of quality of healthcare delivery

To evaluate success of a structured plan implemented in a tertiary care hospital in terms of an evidence based hypoglycemia management protocol, traingning & awareness among all nurses in the organization and promoting a reward based reporting system.

A prospective observational study was conducted over 3 year period. A inhouse hypoglycaemia management protocol designed based on international guidelines. The protocol was included in the induction training programme of nurses and implemented in wards under guidance of master trainers. Each episode of hypoglycaemia reported and managed was logged into centralised database, Quality Flash Matrix(QF). The QF was analysed at end of each 24 hours cycle to carry out a root cause analyses. Based on findings, the master trainers made appropriate correction in training modules. Data extracted from hospital records, patient case records and QF in terms of total number of cases receiving insulin, total number of episodes of hypoglycaemia documented and reported

Incidence of hypoglycaemia recorded was 6.4,5.3,4.7 per 1000 patient hours for year 2009,10 and 11 respectively. The percentage of episodes of hypoglycaemia reported improved from 78% (1^st quarter 2009) to 100% (4^th quarter 2011). Root cause analysis showed change in diet of patient with no corresponding change in insulin and viceversa being the commonest cause for hypoglycaemia consistent over the study period.

Constant structured training of nurses, constant surveillance and appropriate feedback analysis results in decreased incidence of hypoglycaemia and increased reporting of episodes of hypoglycaemia.