In patients with diabetes, there is a discordance between the documented times for checking blood glucose levels (BGL) and the times checks are actually being performed. Anecdotal evidence from our health service indicates wards are often performing blood glucose testing 1-2 hours before the prescribed time and later administering insulin based on these earlier results. The rationale given by Nurse Unit Managers (NUM) and Registered Nurses (RN) is that it allows nurses to manage daily tasks in a timely manner. A recent audit showed 25% of our inpatients have diabetes and there are a large proportion of inpatients that may have their glycaemic control influenced by the suboptimal timing of blood glucose measurements. Patients with diabetes are more likely to have increased length of stay than those without diabetes. Up to half of total medical expenditure for diabetes is incurred by inpatient care (1). Suboptimal blood glucose control exposes inpatients to the risks of unstable diabetes which include diabetic ketoacidosis, major hypoglycaemia, dehydration and infection.
1. Survey NUM’s and RN’s to determine:
• Documented times for checking BGL’s
• Actual times BGL’s are being performed
• Timing of insulin administration
2. Develop an education program addressing recommended clinical practice
The Diabetes Educators approached NUMs and RNs in each ward with a specially developed questionnaire & recorded their responses.
An historical culture was described “we always do it at these times”. NUMs and RNs reported different results. 53% of wards are testing at inappropriate times and documenting results incorrectly.
Results confirmed nursing staff often perform blood glucose testing 1-2 hours before the prescribed time and document incorrectly. This may adversely affect insulin dose titration. An education program for all staff to raise awareness and improve clinical care is being developed.