1987 Capillary blood glucose testing on older inpatients at the Norfolk and Norwich University Hospital (NNUH)

Abstract

Abstract Rationale Inpatient glycaemic management is a challenge in older people. Clinicians at the Norfolk and Norwich University Hospital noticed substantial numbers of finger-prick capillary blood glucose (CBG) tests being documented. This quality improvement project explored the frequency of CBG testing on older people’s medicine wards, to determine if improvements in service provision and patient safety could be made. Methods Setting: Electronic records of inpatients on geriatric medicine wards at NNUH (May-July 2023) Patient selection: Older people with recorded CBG testing Measures: Type of diabetes, medication regime and frequency of CBG testing. Staff survey of CBG monitoring knowledge. Analysis: Compliance with the Joint British Diabetes Societies for Inpatient Care guidelines for frail older adults with diabetes (February 2023). Staff knowledge. Results 240 inpatients included - 23% had type 2 diabetes. 32% had regular CBG monitoring (once daily or more). Of these patients, 70% had tests that were not compliant with guidance. In a single day, we calculated 120 CBG tests that were not clinically indicated. 43% of patients were on single-therapy treatment (not including sulphonylureas) or diet-controlled type 2 diabetes, all of whom underwent excessive testing during their inpatient stay. A staff survey of 15 ward sisters, nurses and healthcare assistants revealed no consensus on who determines frequency of CBG testing and target CBG ranges for frail, older inpatients. Conclusions Ad hoc CBG testing has resulted in potential harm to our inpatients and overuse of staff time and resources. Future work is underway to ‘Think Glucose’ and implement protocols for appropriate CBG monitoring frequencies and target CBG ranges for our inpatients.