O26\u2005Impact of a multiple, short duration in-situ simulation on inpatient diabetes management – a pilot study

Abstract

Introduction The relation between dysglycaemia and morbidity, cost of hospitalisation and mortality is well established.1 Even in the presence of established guidelines, human factors may play an important role in the insufficient control of diabetes. The identified gaps include contextual and biomedical knowledge, attitudes, clinical inertia, confidence, and familiarity with existing hospital resources and guidelines with regards to hospital diabetes care.2 Adherence to guidelines for inpatient diabetes management has shown to be greater with repeated training.3 Management of blood glucose in an in-patient requires basal-bolus insulin therapy, regular glucose monitoring, as well as enhancing healthcare provider’s role and knowledge.4 Implementation of training in practice is challenging, mainly due to increasing workload burden on staff and fear of hypoglycaemia. We seek to demonstrate the efficacy of multiple, short duration in-situ simulation; a pilot study in a ward to improve outcomes in patients with diabetes. Methodology This study will be conducted in the Ward 70 of the Hull University Teaching Hospital. In the first week, 6 patients with diabetes on insulin will be chosen and their blood sugar recordings will be noted. The insulin therapy and adherence to guidelines will be noted. Also noted will be the number of hypoglycemic episodes. This will serve as the baseline-our current data suggests that there is inadequate adherence in this area. In the second week an in-situ simulation will be delivered replicating hypoglycemia and diabetic ketoacidosis. This will be repeated twice a week for 3 weeks. Every week data will be collected on the adherence to guidelines in the ward from the medical records of patients with diabetes on insulin. Data will be analysed for number of episodes of dysglycaemia (< 4 mmol/L and > 14 mmol/L) and deviation from the hospital protocol. This is an ongoing study and is expected to be completed in 8 weeks. Discussion Continuing education to health care professionals is essential to improve patient outcomes and can be provided as in-situ simulation.2 We believe that this study will form the basis for further research in using low dose high frequency methodology of in-situ simulation for improving ward based care. We believe that our project is unique in identifying whether this methodology can be used for medical patients in a busy tertiary care hospital. If found effective and feasible we hope to share our results widely and replicate this model in other wards and other hospitals in our region. References Schmeltz LR, Ferrise C. Glycemic management in the inpatient setting. Hosp Pract1995. 2012 Apr;40(2):44–55. Pichardo-Lowden A, Haidet P, Umpierrez GE. Perspectives on learning and clinical practice improvement for diabetes in the hospital: a review of educational interventions for providers. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2017;23(5):614–26. Alkhiari R, Alzayer H, Aljazeeri J, Vanniyasingam T, Punthakee Z. Adherence to Guidelines for Inpatient Pharmacologic Management of Type 2 Diabetes in Adults and Glycemic Outcomes. Can J Diabetes. 2018 Apr;42(2):158–62. Thabit H, Hovorka R. Glucose control in non-critically ill inpatients with diabetes: towards closed-loop. Diabetes Obes Metab. 2014 June;16(6):500–9.