Background:
Inpatient hyperglycaemia, especially after hours, is frequently managed sub-optimally. Attending Junior Medical Officers (JMOs) are often not part of the patient’s admitting team and are unfamiliar with the clinical circumstances.
A clinical audit was conducted to determine current JMO response to after-hours hyperglycaemia.
Aims:
Methods:
A record of all inpatient Clinical Reviews at Hornsby Ku-ring-gai Hospital from January 2022 to March 2022 was obtained. Clinical reviews for all episodes of hyperglycaemia (blood glucose level (BGL) >20mmol/L) that occurred from 1600 hours to 0800 hours were examined for: clinical assessment, glucose management, management escalation, patient monitoring, and follow-up/handover.
Results:
Dysglycaemia was the second most common reason for all clinical reviews. Among these, 55% (134/243 reviews) were for hyperglycaemia, with 71% (95/134) of these reviews occurring after hours. Blood ketone levels (BKLs) were only documented in 64% of reviews. BKLs were not documented for 25% of patients with type 1 diabetes. Patients were physically reviewed in 39% with the majority reviewed remotely. Most patients were managed with a prescription of rapid-acting insulin on an ad-hoc or stat dose basis. This resulted in insulin ‘’stacking’’ in 10 patients, with one patient receiving 22 units cumulative dose of rapid acting insulin in a four-hour time frame. Only 16% of clinical cases were discussed with the after-hours Medical Registrar. A plan for monitoring BGLs was communicated in 82% of cases, although significant variability existed in these plans.
Conclusion:
This audit identified significant areas for improvement in the after-hours management of inpatient hyperglycaemia. Further education for JMOs and nursing staff regarding the appropriate management of hyperglycaemia in hospital settings, especially after hours is needed.