SAT-270 Outcomes of a Quality Improvement Project Integrating Continuous Glucose Monitoring Systems into rhe Routine Management of Neonatal Hypoglycaemia

Abstract

Introduction Continuous glucose monitoring systems (CGMS) are safe and can optimize neonatal hypoglycaemia management. However, they need to be tested within resource-limited clinical practice. CGMS was piloted in our Neonatal Intensive Care Unit (NICU) in June 2017. Five barriers to its effective implementation were identified: 1) Lack of staff confidence in device usage 2) Infant discomfort during device removal 3) Calibration errors 4) Wireless connection disruptions 5) Bruising after device removal. We designed a quality improvement project that aimed to reduce the number of problems per patient associated with CGMS use in our NICU from 5 to 0 over a 1 month period. Methods This study was conducted in July 2017. Eligible for inclusion were term neonates >1.5kg who were admitted for hypoglycaemia (<2.6mmol/L) <48 hours old. A New Generation EnliteTM Sensor (Medtronic, California) was inserted into five consecutive babies admitted with hypoglycaemia and removed when normoglycaemia was achieved. The sensor transmitted interstitial glucose readings to a MinimedR REAL-Time Transmitter and displayed values on a MiniMedR 530G System (both Medtronic, California). Five "Plan-Do-Study-Act" (PDSA) cycles tested the change intervention. Results The first two cycles tested CGMS acceptability and practicality of the device using qualitative feedback from staff and families, and quantitative data from the Neonatal Infant Pain Scale (NIPS). Subsequent cycles optimised the insertion process, trouble-shooting calibration errors and promoting NICU staff confidence in device usage. Key recommendations included manually inserting the device on small babies, using Duoderm® to reduce subcutaneous bruising, timely insertion of calibration readings to avoid sensor errors, adaption of nursing cares to avoid signal loss, and using near-peer teaching techniques to educate staff on CGMS usage. Bland-Altman analysis comparing point-of-care and sensor glucose readings showed no significant proportional bias Conclusions PDSA cycles revealed aspects of CGMS use that need to be adapted for its successful implementation in clinical practice. Further studies should assess the potential of CGMS as a decision-making tool in hypoglycaemia management.