None listed
Conditions
Brief summary
It is very common for people with diabetes to require admission to hospital, sometimes for reasons that are unrelated to diabetes. In the Acute Medical Unit at the Launceston General Hospital, over 50% of the patients admitted have diabetes. There is evidence that people with diabetes admitted to hospital for most illnesses are more prone to develop complications and take significantly longer to recover. This is thought to be related to their blood glucose levels being higher than normal: being unwell, eating different foods, changes to medications, stress, pain and having reduced physical activity can all result in high blood glucose levels. Managing diabetes in these circumstances can be difficult, and many doctors, especially junior medical staff, do not have enough experience in prescribing insulin to be able to keep the patient’s blood glucose levels under good control. We plan to introduce tools into the Acute Medical Unit that will improve the way patients with diabetes are currently managed: these tools consist of a specialized chart for prescribing insulin and specific education on how to control glucose levels in acutely ill patients. We will measure the effect of this intervention by collecting information on blood glucose levels in patients in the Acute Medical Unit before and after the new tools are introduced, as well as surveying patients for their opinions on their diabetes care at both time points. We will also determine if our intervention has changed the attitudes of doctors to managing diabetes in their acutely ill patients. Our objective in carrying out this project is to improve outcomes for patients with diabetes who are admitted to the Acute Medical Unit: we anticipate that our intervention can achieve this, with significant benefits to the patients themselves and also potentially to hospital healthcare costs.
Interventions
Introduction of specific chart for prescription of subcutaneous insulin, based on National insulin prescription chart, along with education program for medical and nursing staff. The prescription chart enables clinicians (medical staff) to prescribe basal, pre-meal or premixed insulins, along with correction doses of rapid-acting insulin, adjusted on a daily basis. The chart is designed to allow prescription and monitoring of blood glucose levels for 5 days - after which a new chart will be used
Introduction of specific chart for prescription of subcutaneous insulin, based on National insulin prescription chart, along with education program for medical and nursing staff. The prescription chart enables clinicians (medical staff) to prescribe basal, pre-meal or premixed insulins, along with correction doses of rapid-acting insulin, adjusted on a daily basis. The chart is designed to allow prescription and monitoring of blood glucose levels for 5 days - after which a new chart will be used for the patient. The chart also records blood glucose levels, enabling a comprehensive view of a patient's diabetes management. The chart replaces a conventional drug chart which is not designed for prescription of multiple daily insulin injections, plus a blood glucose monitoring chart. The education program will be delivered by an experienced diabetes nurse educator working in the Acute Medical Unit. The education program consists of a weekly series of tutorials (30 mins) for junior medical staff and nursing staff in the Acute Medical Unit over one month period prior to adoption of the new prescription chart, with follow-up tutorials (twice-monthly) post-adoption of the chart as required (i.e. to educate new staff rotating through to unit and for maintenance of the required standard of insulin prescription). Topics included in the education sessions are: how to prescribe correctly using the chart, how to determine initial insulin doses, how to treat hypoglycaemia, how to treat hyperglycaemia. A register of staff attendance at education sessions will be kept. After a run-in period for the new prescription chart of 1 month, outcomes will be evaluated at + 3 months and +6months i.e. the new chart will continue to be used for 7 month duration of the trial (1 month run-in, then +3 months, + 6 months) i.e. with collection of data September 2016 - February 2017.
Sponsors
Dr Anne Corbould
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
The group of patients will be disparate, reflecting real-world clinical practice i.e. inclusion criteria will be broad: Patients requiring subcutaneous insulin on admission to AMU – whether or not previously treated with insulin Patients with known diabetes (Type 1/Type 2) or no previous diagnosis of diabetes. Duration of admission 48 hours or greater. Hospital staff to be included in the survey of knowledge/attitudes regarding inpatient diabetes management are: interns and resident medical officers who work in the AMU on rotation, consultant physicians who are permanently based in the AMU, and nursing staff who are permanent AMU staff and also on rotation in the AMU.
Exclusion criteria
Patients admitted with diabetic ketoacidosis Patients who are not eating and/or requiring intravenous insulin Patients whose prognosis is so poor that management of hyperglycaemia is not indicated. Exclusion criteria for hospital staff are speciality junior medical staff and consultant physicians whose patients are occupying an AMU bed, but are not cared for by the AMU medical staff.
Outcome results
None listed