Scottish Patient Safety Program

Glycaemic ControlMonklands ITU

Aims

• Blood Glucose Range 3.5 – 8.5 mmol/l• 80% of measurements within target range• Avoid hypoglycaemia - <3.5mmol/l

• Recently changed target glucose range 4.4 – 10.0 mmol/l

Tools

DISEASE

US

PATIENTS• Raw data• Data display• ANNOTATIONS

Allowed hypotheses to be made

Our System

Example…

Over Time…

MONKLANDS

HAIRMYRES

WISHAW

What did we do? - 3 Phases1. A Better Protocol• Management of insulin

and feed• Frequency of monitoring• Dosing of insulin• Steroids by infusion rather

than bolus

At this stage, we avoided different protocols for different patients.

What did we do? - 3 Phases

1. A Better Protocol2. Follow the ProtocolLong process of discussion with staffHow do you keep control of blood glucose?Segment1. Experience vs non experience2. Busy unit

What did we do? - 3 Phases

1. A Better Protocol2. Follow the Protocol3. Redundancy – June 2009

• Safety Briefings at morning handover

• Importance of glycaemic control reiterated and latest compliance figures pointed out to staff – FEEDBACK

• Nurses put in pairs – more senior with more junior to help with management of blood glucose– spread the experience

DISEASE

US

PATIENTS

US

PROCESS STRUCTURE

Now…

• Hypoglycaemia rate 0.43%

So What?• Compliance increased from 74% to 82%

– Important?– For how long?

• Lessons– Change is possible but may not be quick – many useful changes– We can apply this method – what next?– The system fails to use staffs’ abilities– Work together– Telling people to do things differently is not enough – measure,

investigate– Steal Ideas!