Strategies to improve in-hospital hypoglycaemic management have been implemented and evaluated since at least 1992 (Lehmann1 ). Since then most hospitals have used ‘hypo-kits’ and protocols to assist staff to identify, treat and monitor hypoglycaemia. A consistent hypoglycemia management protocol and flowchart was developed and introduced across eight metropolitan public hospitals in South Australia between late 2007 and early 2010. An audit of the hypoglycaemia management was conducted in older adults (aged 65 or above) with diabetes admitted to a metropolitan public hospital in South Australia between 1st June and 31st August, 2012.
To examine bedside nurses adherence to the current hospital hypoglycaemia management protocol.
A retrospective case note audit of people with diabetes aged 65 or older admitted to the 400-bed public hospital from 1st June to 31st August 2012 was conducted. A total of 180 case notes were examined to identify blood glucose levels (BGL) below 4.0mmol/L. Fifty hypoglycaemic episodes were identified in patients with diabetes in medical wards, surgical wards, intensive care unit, mental health units and rehabilitation units. Each hypoglycaemic episode was audited according to the hypoglycaemia management audit tool from the diabetes education unit in the hospital.
In 22 out of 50 cases (44%), the correct amount of Carbotest drink was given as the first step treatment according to the protocol. Nursing documentation of hypoglycaemic assessments and symptoms was incomplete in 45 of the 50 hypoglycaemic episodes (90%). The Step 2 treatment of complex carbohydrate after the BGL rose above 4.0mmol/L occurred in only 20 out of 50 cases (40%).
Bedside nurses’ adherence to the current hospital hypoglycaemia management protocol was suboptimal. Nursing documentation on the assessment of hypoglycaemic symptoms is insufficient. In conclusion, the current hospital hypoglycaemia management needs improvement with a new approach to staff development.