Scottish Patient Safety Program Glycaemic Control Monklands ITU
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!