The rate of hospital admissions for people with hypoglycaemia is concerning. Most admitted patients are referred to the Diabetes service however the presentations occurring outside hours or not requiring admission is unknown. The Diabetes service is available Monday to Friday, 08.00-16.00 hours.
The opportunity to re-educate these unknown presenting patients is currently lost.
Audit Hypoglycaemia presentations to Department of Emergency to identify enhanced education opportunities.
A report from Emergency Department Information System comprising all presentations to the Nambour Hospital, over 18 years, by diagnosis (diagnostic codes related to hypoglycaemia) and other diabetes related problems for 2013 was generated. Data was cross-referenced with Hospital Based Corporate Information System and PractiX records.
There were 65 occasions of service presenting to DEM with hypoglycaemia during the time period. One patient over the age of 65 years was admitted three times and another two patients were admitted twice.
Of all the total presentations, 48 were admitted to either medical or short-stay wards and one was transferred. Twenty four patients were known to the diabetes service. Thirty one were over age 65 years (48%).
Thirty –six occurred outside service hours. Twenty presented between 16.00 hours and 21.00hours and a further 16 presented from 21.00 hrs to 08.00hrs.
1. Offer a CDE service between 16.00 and 21.00 hours
2. Provide an on-call CDE service
3. Implement referral process for CDE to follow-up patients
4. Up-skill DEM nurses to educate patients
5. Trial carers management guide
The Way Forward
Point three and four above is the most cost effective, sustainable way of managing these patients where they can be scheduled an appointment or phone consultation with the CDE. Daily EDIS reports of those over 65 years presenting to DEM with hypogycaemia are sent to the NUM.. The development of a Carers Guide to highlight individual symptoms signs and treatment of hypolycaemia is underway.The next step is to meet with DEM personnel to discuss implementation of this proposed pathway.