The best hypoglycaemia avoidance initiative in the UK

Dashora, Umesh; Sampson, Mike; Castro, Erwin; Stanisstreet, Debbie; Hillson, Rowan

doi:10.15277/bjd.2017.126

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…The review focussed on interventions that can be implemented by local health services, that have been evaluated and where the evaluation findings were published in a peer‐reviewed journal. This meant we did not search the grey literature or include national initiatives, such as national competitions that reward innovative ways to reduce hypoglycaemia, 16 in this review. These sources may still provide inspiration for local stakeholders looking for innovative options, however, further evaluation may be required alongside implementation.…”

Section: Discussionmentioning

confidence: 99%

Pragmatic review of interventions to prevent inpatient hypoglycaemia

et al. 2021

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Aims: This pragmatic review aimed to map and summarize the literature on model of care interventions to prevent inpatient hypoglycaemia. Model of care interventions were broadly defined as interventions that either directly target the workforce or where implementation had a strong workforce effect. The review intended to provide information for decision-makers in local health care settings regarding potential interventions to prevent inpatient hypoglycaemia in their local context. Methods: PubMed, Embase, CINAHL Plus and Scopus were systematically searched from 2009 to 2019 using key search terms for hypoglycaemia and hospital and evaluation. Included articles had to report an inpatient hypoglycaemiarelated outcome. Interventions were categorized by intervention type and setting. Dysglycaemia outcomes were extracted (severe-hypoglycaemia, hypoglycaemia, hyperglycaemia and severe-hyperglycaemia).Results: Forty-nine articles were included in the review. Interventions were categorized as: services (n = 8), role expansion (n = 6), education (n = 9), audit and feedback (n = 1), alerts and reminders (n = 3), protocol implementation methods (n = 1), order sets (n = 6), insulin charts (n = 1) and electronic glycaemic management systems (n = 14). Twenty-one articles reported on ICU-specific interventions, and 28 on interventions in non-ICU-specific settings. Study designs were predominantly non-randomized (n = 40). Conclusions: The review found positive evidence for a diverse range of evaluated interventions to prevent inpatient hypoglycaemia. Local decision-makers can use this review to identify interventions relevant to their local context. We suggest they evaluate those interventions using a decision analytic framework that combines the published evidence on effectiveness with local prevalence data to estimate the expected cost-effectiveness of the intervention options when implemented in their local context.

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Section: Discussionmentioning

confidence: 99%

Pragmatic review of interventions to prevent inpatient hypoglycaemia

et al. 2021

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“…Following the success of previous contests, [3][4][5][6][7][8] the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) launched the seventh round of this national competition in 2022 to find the best interventions that encompass redesigning, rebuilding and main-taining safe inpatient diabetes care during COVID so that effective projects can be identified, rewarded and shared with other Trusts in the UK. The project was led by Dr Umesh Dashora and Erwin Castro of the JBDS Inpatient Safety Group.…”

Section: Methodsmentioning

confidence: 99%

Rowan Hillson Inpatient Safety Award 2022

Dashora

Kempegowda

et al. 2022

Br J Diabetes

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Introduction: The annual National Diabetes Inpatient Audit (NaDIA and NaDIA-Harms) in the UK continues to show signiﬁcant problems with patient care. During the COVID pandemic patient care has been even more difﬁcult. New initiatives are urgently required to improve inpatient safety for people with diabetes. Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the seventh national Rowan Hillson Inpatient Safety Award on the theme of “the best interventions: redesigning, rebuilding and maintaining safe inpatient diabetes care during COVID”. Result: The winner was the DEKODE team, led by Dr Punith Kempegowda from University Hospitals Birmingham NHS Foundation Trust, for their innovative quality improvement project across hospitals during COVID to improve diabetes-related ketoacidosis (DKA) management and study DKA in people with COVID. Adherence to national guidance improved in some hospitals, with falls in hypoglycaemia, and overall there was a signiﬁcant improvement in awareness about DKA amongst junior doctors. The King’s College NHS Foundation Trust team, led by Adrian Li and colleagues, received the highly commended award for their innovative project of remote blood glucose (BG) monitoring across healthcare boundaries. This improved diabetes control and tackled health inequalities. Summary and conclusion: These and similar schemes need to be developed, promoted and shared to improve safety for people with diabetes admitted in hospital during COVID times.

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“…Following the success of previous contests, [2][3][4][5][6] JBDS-IP launched the sixth round of this national competition in 2019 to find the best perioperative pathway for people with diabetes so that effective projects can be identified, rewarded and shared with the other Trusts in the UK.…”

Section: Methodsmentioning

confidence: 99%

The Rowan Hillson Inpatient Safety Award 2019 for the best perioperative pathway for people with diabetes

Dashora

Laurent²,

Leech³

et al. 2021

Br J Diabetes

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Introduction: The annual National Diabetes Inpatient Audit (NaDIA) in the UK continues to show a high incidence of insulin errors in patients admitted to hospital with diabetes. New initiatives are urgently required to mitigate this risk.Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the sixth national Rowan Hillson Inpatient Safety Award on the theme of the best perioperative pathway for people with diabetes.Result: The winner was the team from Aneurin Bevan University Health Board led by Dr David Burckett-St Laurent for their innovative re-design of the perioperative pathway by a cross-specialty working group. The main elements of the new system were standardised patient assessment, optimisation of perioperative diabetes control, personalised diabetes management plans generated from a drop-down menu with information on usual drug treatment, pre-op/day of surgery diabetes medication modification, advice on hypoglycaemia management and sick-day rules, anaesthetic review for people with HbA1c >69 mmol/mol, secondary care diabetes review for people with suboptimal diabetes control, new inpatient charts with guidance on diabetes drug management, streamlining of time and place of admission and greater engagement and education of people with diabetes and staff looking after them. This resulted in significant improvement in outcomes and reduction in risks.The Newcastle upon Tyne NHS Foundation Trust team led by Dr Nicola Leech and colleagues received the runners-up award for their 3-year quality improvement project involving multiple specialties. The project included development of trust-wide policies and protocols, educational initiatives, targeted diabetes specialist nurse in-reach, innovative electronic whiteboard alerts for glycaemic control and electronic hypo alerts. The result was a reduction in insulin errors and hypoglycaemia on surgical wards by over 50%, a reduction in Datix incidents and fewer patients suffering harm events.Summary and conclusion: These and similar schemes need to be developed, promoted and shared to reduce insulin errors in hospitalised patients with diabetes.

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The best hypoglycaemia avoidance initiative in the UK

Abstract: Introduction: The annual National Diabetes Inpatient Audit (NaDIA) in the UK continues to show a high incidence of hypoglycaemia in people with diabetes admitted to hospital. It is clear that initiatives are urgently required to address this risk.

Cited by 8 publications

References 12 publications

Pragmatic review of interventions to prevent inpatient hypoglycaemia

Pragmatic review of interventions to prevent inpatient hypoglycaemia

Rowan Hillson Inpatient Safety Award 2022

The Rowan Hillson Inpatient Safety Award 2019 for the best perioperative pathway for people with diabetes

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