A quality improvement project reducing adverse events and improving adherence to guidelines surrounding VRIII usage

Area of Science:

• Endocrinology
• Metabolic Disorders
• Hospital Pharmacy

Background:

• Variable rate intravenous insulin infusions (VRIII) are critical in hospital settings but carry risks like electrolyte imbalance and hypoglycaemia.
• Joint British Diabetes Societies (JDBS) guidelines recommend balanced fluids for VRIII to mitigate adverse events.
• Previous data on the superiority of balanced fluids in reducing adverse events was limited.

Purpose of the Study:

• To assess the impact of implementing JDBS-recommended balanced fluids on VRIII practice within a hospital trust.
• To reduce adverse events, specifically hypokalaemia and hypoglycaemia, associated with VRIII.
• To provide data supporting the long-term availability of balanced fluids for VRIII.

Main Methods:

• A quality improvement project involving an audit of VRIII practices before and after guideline implementation.
• Rewriting VRIII guidelines to recommend balanced fluid (0.45% sodium chloride/5% dextrose with 0.15% potassium chloride).
• Monitoring key metrics including correct fluid use, hypoglycaemia, hypokalaemia, and hyponatraemia events.

Main Results:

• Correct balanced fluid use increased significantly from 11% to 76% post-intervention (p<0.0001).
• Hypoglycaemic events per VRIII decreased from 0.73 to 0.28 (p<0.05).
• Hypokalaemic events per VRIII reduced from 0.15 to 0.05, and hyponatraemia events decreased from 26% to 12% (p<0.01).

Conclusions:

• Implementation of JDBS-recommended balanced fluids for VRIII led to significant reductions in adverse events and cost savings.
• Sustained improvements were observed, highlighting the effectiveness of updated guidelines, education, and awareness campaigns.
• This project supports the adoption of balanced fluids for safer and more cost-effective VRIII management.