Background and aim Capillary blood glucose (CBG) monitoring is important in the hospice inpatient (IPU) setting. Many patients require monitoring due to diabetes or steroid therapy. Hyper and hypoglycaemia can both cause significant symptom burden, and untreated can potentially lead to needing emergency treatment in hospital. Through working in the IPU, it was noted that our monitoring was inconsistent and the charts were confusing. Our aim was that 80% of inpatients would have their CBGs correctly monitored as per Diabetes UK guidelines.
Methods We performed repeated snapshot audits of CBG monitoring by reviewing the charts of all current inpatients on random days over a period of thirty months. Following each audit, interventions were introduced and the impact was assessed using plan, do, study, act methodology. The following interventions were utilised;
· Posters and email reminders to promote awareness of correct CBG monitoring.
· A single monitoring chart was designed to replace 4 previously in use, with a chart placed in all patient notes as standard.
Transcription of dates on chart to help trigger checks on appropriate days.
Revision of monitoring charts.
Results Correct monitoring of CBGs improved from 0% to 58%. The most common errors at the beginning were too frequent monitoring of CBGs and no check on day of commencing steroids. Error count dropped from 38% and 31%, respectively, to 0%.
Conclusions Whilst not yet achieving our 80% standard, CBG monitoring has significantly improved. This quality improvement project has led to changes in practice within our IPU by reducing the burden of unnecessary CBG checks, ensuring checks when steroids are commenced and highlighting new hyper or hypoglycaemic events in our patients allowing timely adjustment of anti-hyperglycaemic treatment. This project has standardised care, brought monitoring in line with Diabetes UK guidelines and improved patient comfort and safety.
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