Improving the Clinical Interpretability of Inpatient Blood Glucose Monitoring Through a Standardized Documentation...

Introduction Accurate inpatient blood glucose documentation is essential for safe diabetes management, yet paper-based monitoring systems often record glucose values at clock time rather than during physiologically relevant monitoring periods. This quality improvement study evaluated whether implementing a standardized, timing-based diabetes monitoring chart improved the completeness and clinical interpretability of inpatient blood glucose documentation at a tertiary public hospital in the Caribbean. Materials and methods A two-cycle clinical audit was conducted over six months. Twenty-five adult medical inpatients with type 2 diabetes mellitus were evaluated before and after implementation of the intervention. The intervention consisted of a redesigned paper-based diabetes monitoring chart implemented hospital-wide, which recorded blood glucose measurements during pre-breakfast, pre-lunch, pre-supper, and bedtime monitoring periods, with adjacent documentation of insulin administration and staff education. The primary outcome was the proportion of clinically interpretable diabetes monitoring charts. Secondary outcomes included documentation of meal-related blood glucose timing, insulin administration in close proximity to blood glucose measurements, and incomplete diabetes monitoring charts. Results A total of 50 patient records were reviewed. Clinically interpretable documentation increased from 10/25 (40%) at baseline to 23/25 (92%, p < 0.001) following implementation. Documentation of meal-related blood glucose timing improved from 9/25 (36%) to 23/25 (92%, p < 0.001), while documentation of insulin administration adjacent to blood glucose measurements increased from 14/25 (56%) to 24/25 (96%, p < 0.001). Overall compliance with predefined documentation standards improved from 11/25 (44%) to 23/25 (92%, p < 0.001), and the number of incomplete diabetes monitoring charts decreased from 8/25 (32%) to 2/25 (8%, p = 0.074). Conclusions Implementation of a standardized timing-based diabetes monitoring chart was associated with marked improvements in the completeness and interpretability of inpatient blood glucose documentation. This simple, low-cost quality improvement intervention may enhance inpatient diabetes documentation in hospitals that continue to rely on paper-based medical records and could be adapted for use in other resource-limited healthcare settings.