Inpatient hypoglycaemia: a study of nursing management

Optimised glycaemic management during hospital admission is critical to good patient outcomes. Inpatient hypoglycaemia is associated with increased morbidity and mortality during the hospital stay and post-discharge. To mitigate the deleterious effects of hypoglycaemia, many hospitals have an inpatient protocol to guide clinicians. Earlier research has shown that nurses fail to follow such protocols. This descriptive study used a retrospective audit of inpatients' treatment and progress notes to examine nursing adherence to a hypoglycaemia protocol. Adult medical and surgical inpatients with Type 1 or Type 2 diabetes mellitus and who had experienced hypoglycaemia during a three month period were included. One hundred and seventeen episodes of hypoglycaemia were identified in 32 patients who met the inclusion criteria. A predominance of these, 29 patients (90.6%), had Type 2 diabetes with 20 (62.5%) of the sample being medical patients. Diabetes medications included the use of insulin only (n = 18, 56.2%), oral hypoglycaemic agents only (n = 9, 28.1%) and five patients (15.7%) received a combination of these therapies. Three of the 117 episodes were treated with administration of intravenous glucose whilst the remaining 114 episodes were able to be treated with oral therapy. The recommended oral treatment to correct hypoglycaemia is 9-15 grams of glucose only. Adherence to most steps of the hypoglycaemia protocol was low. Initial treatment with glucose was administered in 46 (40.4%) cases. The required repeat capillary blood glucose test in 10-15 minutes was obtained in 35 (30.7%) cases. Within thirty minutes of detection, only 36.7% of episodes were corrected. A high degree of prolonged and recurrent hypoglycaemia was identified, with 40% of the episodes lasting more than one hour, and 72% of patients having more than one hypoglycaemic episode during their admission. Recommendations from the study include review of the hypoglycaemia protocol, development of strategies to help nurses prioritise the management of hypoglycaemic episodes, ongoing education for nurses, and regular re-audit.