Background: A NSW Health subcutaneous insulin prescribing chart was introduced at Prince of Wales Hospital in February 2014. With its introduction, an education program was undertaken. Aim: to determine whether the new insulin chart coupled with the education program was effective in improving patient safety and glycaemic control on inpatient wards. Method:(i) Qualitative review of Incident Information Management System (IIMS) reports 3 months before the introduction of the chart and 3 months after the introduction of the chart. (ii) Quantitative assessment of blood glucose control on inpatients. Capillary blood glucose (BG) readings were extracted from point of care BG meters from inpatient areas using proprietary software. The last 3 months readings one week prior to chart implementation and 3 months later were downloaded.
Results: At baseline, mean BG for various wards ranged from 7.6-10.3mmol/L. Ward areas with highest proportion of BG readings above 10mmol/L (around 40%) provided care for speciality medical patients. The rate of hypoglycaemia ranged from 0 to 7.5% with highest rate on surgical wards where the lowest mean BG of all surgical wards was seen (7.7mmol/L). Preliminary results subsequent to the introduction of the new insulin chart showed an improvement in mean BG of a speciality medical ward (from 10.2 to 9.4mmol/L p < 0.05). For a surgical ward the mean BG rose from 7.6 mmol/L to 8.6mmol/L P<0.05, and rate of hypo fell to only 3.4% but rate of hyperglycaemia rose to 26.6%.Most ward area showed no change in mean BG. Analysis of hyperglycaemia and hypoglycaemia rates are in progress. IIMS analysis showed a reduction in the numbers insulin incidents.
Conclusion: Education programs for staff need to be tailored to specific needs of each ward. In particular as attempts are made to achieve recommended targets, the potential for an increased risk of hypoglycaemia needs to be addressed.