None listed
Conditions
Brief summary
In the inpatient peri-operative setting, people with diabetes are at risk of dysglycaemia precipitated by a number of factors, for example prolonged fasting, use of blood glucose lowering agents, stress, fever, infection and pro-inflammatory state. In addition, delayed BGL monitoring and medication errors relating to insulin and oral hypoglycaemic agent doses and administration can cause further fluctuations in BGLs and contribute to increased hospital length of stay and surgical complications. Standard POC glucose testing requires manual input by nurses into the EMR, which can lead to error and delay in transcription of the BGL value. The standard POC BGL testing also does not enable easy auditing of BGL data, so that interventions to improve BGLs are difficult as they require time consuming manual audits of sequential BGLs over time e.g. to assess adherence to protocol in treatment of hypoglycaemia. This is a prospective pre- and post-intervention observational study to determine whether early identification of dysglycaemia, using a blood glucose meter with Wi-Fi connectivity to the EMR and an early identification system can facilitate prompt assessment and management to improve patient outcomes. The patient outcomes are, comparing use standard care POC BGL testing with Wi-Fi connectivity glucose meters, the mean proportion of BGLs per patient in the hospital inpatient target range of 5-10 mmol/l , the mean proportion and number of patient days with hypoglycemic incidents and with hyperglycaemic incidents, the average length of stay, 28 day readmission rates, and post-operative complications including but not limited to surgical site infections. We will also measure time to first assessment of dysglycaemia by the glucose control team, both from admission and from arrival on one of the surgical wards. We hypothesise that use of the connectivity glucose meter will identify patients who require clinical intervention earlier and will improve glycaemic control, post-operative surgical outcomes, decrease the mean length of stay and decrease 28-day readmission rates.
Interventions
The aim of this study is to evaluate whether prompt assessment and management intervention by the diabetes glucose control team can improve the average length of stay, 28 day readmission rate or post-operative complications in surgical inpatients with diabetes mellitus. Prompt delivery of the intervention will be facilitated by use of a Point of Care (POC) glucose meter with Wi-Fi connectivity (Nova Biomedical Statstrip Connectivity meter), which has been approved by the Therapeutic Goods Admini
The aim of this study is to evaluate whether prompt assessment and management intervention by the diabetes glucose control team can improve the average length of stay, 28 day readmission rate or post-operative complications in surgical inpatients with diabetes mellitus. Prompt delivery of the intervention will be facilitated by use of a Point of Care (POC) glucose meter with Wi-Fi connectivity (Nova Biomedical Statstrip Connectivity meter), which has been approved by the Therapeutic Goods Administration and Nepean Blue Mountains Local Health District for inpatient blood glucose monitoring. Both glucose meters work by detecting the blood sugar in capillary blood taken via a lancet needle. For the Wi-Fi connectivity meters, nurses will need to scan their staff barcode and the patient barcode. Once measured, these Wi-Fi enabled glucose meters can automatically upload blood glucose levels (BGL) into patients' Electronic Medical Records (eMR). BGL are routinely performed at least 4 times a day (e.g. pre-meals, before bed and 2am), and more frequently if indicated (e.g. hyperglycaemia, hypoglycaemia or clinical deterioration). When BGLs are uploaded by the Wi-Fi enabled glucose meters, patients with any BGL measurement that falls outside the hospital inpatient target range (5-10mmol/L) are flagged and emailed to the glucose control team, enabling rapid identification of patients with blood glucose levels (BGLs) which fall outside of this range, indicative of hyperglycaemia or hypoglycaemia. These flagged patients can then be assess by trained glucose control team medical and/or nursing staff. Thus, using this BGL monitoring system, patients can be rapidly identified such that reviews and management can be promptly undertaken to treat dysglycaemia. The standard glucose meters will be removed from the wards once the intervention has started.
Sponsors
Nepean Hospital
Study design
Allocation
Non-randomised trial
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adults who are admitted on the surgical wards at Nepean Hospital with pre-existing diabetes (type 1, type 2 or other types of diabetes, excluding gestational diabetes) treated with diet alone, oral tablets or injectable therapy (e.g. insulin, GLP-1 agonists), who require regular blood glucose testing as part of the standard clinical care, including those already on continuous glucose monitoring.
Exclusion criteria
1. Age under 16 years 2. Patients admitted under a non-surgical team 3. Patients with gestational diabetes or without diabetes 4. Blood glucose measurements by nursing staff who are not trained to use the different types of glucometers (e.g. agency nurses, nursing students)
Outcome results
None listed