Blood Glucose and Hyperglycaemia Management in Hospital for Adults with Diabetes Clinical Guideline V2.0. March 2018

Transcription

1 Blood Glucose and Hyperglycaemia Management in Hospital for Adults with Diabetes Clinical Guideline V2.0 March 2018 Page 1 of 8

2 Summary flow chart for monitoring of blood glucose if >11mmol/L For Adults without a diagnosis of diabetes refer to Diagnosis Guideline Capillary blood glucose < 4mmol/l refer to Hypoglycaemia Guideline Diagnosis of Type 1 Diabetes Capillary blood Glucose > 11 mmol/l Diagnosis of Type 2 Diabetes further action required Elevated capillary blood glucose >15mmol/l Elevated capillary blood glucose >15mmol/l Medical Review of Current Insulin Treatment And consider if any of the following have occurred? 1. Insulin omitted / missed 2. The patient taking steroid therapy? 3. There is any sign of infection? 4. There is any suspicion of Acute Coronary Syndrome? (Refer to Guideline) 1. Test urine for Ketones 2. Administer PRN vorapid as prescribed (if this is outside of meal times must have medical review prior to administration) 2. If ketones present for medical review of patient and usual insulin regimen 3. Repeat capillary blood glucose in 1 hour 4. If capillary blood glucose >15 mmol/l for two consecutive blood sugar readings 1 hours apart: Accompanied by ketones, profound dehydration, intense thirst, polyuria and / or drowsiness consider Diabetic Ketoacidosis immediate referral for medical review t accompanied by ketones, profound dehydration, intense thirst, polyuria and / or drowsiness - Refer to Dr / Diabetes team to assess existing and on-going insulin regimen Monitor glucose trends 4 times a day 2 of 8 Monitor glucose trends twice daily at varying times Medical Review of Current Treatment And consider if any of the following have occurred? 1. Insulin / Tablets omitted / missed 2. The patient taking steroid therapy? 3. There is any sign of infection? 4. There is any suspicion of Acute Coronary Syndrome? (Refer to Guideline) 1. Test urine for Ketones 2. Administer PRN vorapid as prescribed (if this is outside of meal times must have medical review prior to administration) 3. Gain medical review 4. Repeat capillary blood glucose in 1 hour 5. If capillary blood glucose > 33 mmol/l for two consecutive readings 2 hours apart: Commence Intravenous Insulin Infusion and t Accompanied by profound dehydration, Intense thirst, Polyuria or drowsiness - Dr/Diabetes team to assess existing and on-going treatment regimen Accompanied by profound dehydration, intense thirst, polyuria or drowsiness consider Hyperosmolar Hyperglycaemic State (HHS) immediate referral for medical review Elevated capillary blood glucose >33mmol/l 1. Test Urine for ketones 2. If ketones present gain medical review If capillary blood glucose consistently > 15mmol/l without ketones gain medical review of current diabetes treatment

3 1. Aim/Purpose of this Guideline This guideline is for the management of the blood glucose of Adult patients with Diabetes Mellitus within Secondary Care 2. The Guidance Please see Summary flow chart for monitoring of blood glucose if >11mmol/L 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Compliance with the relevant process for patients seen at a Diabetes Team Review. Specialist Adult In-Patient Diabetes Team Patient Documentation Adult in-patients with diabetes who are reviewed by the specialist diabetes team n-compliance will be reported to the responsible medical team, ward /area manager. n-compliance resulting in an adverse patient event will be reported via Datix Relevant Datixes will be reviewed at Endocrine Governance Meeting Medical teams / ward / area managers will undertake subsequent recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes for their areas The Specialist Adult In-Patient Diabetes Team will undertake any trust wide recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes Change in practice and lessons to be shared Lesson learned or changes to practice will be shared with all the relevant stakeholders 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. 3 of 8

4 .Appendix 1. Governance Information Document Title Management of Blood Glucose and Hyperglycaemia in Hospital for Adults with Diabetes Clinical Guideline V2.0 Date Issued/Approved: 23 March 2018 Date Valid From: 23 March 2018 Date Valid To: 23 March 2021 Directorate / Department responsible (author/owner): Amanda Veall Lead Diabetes Specialist Nurse Contact details: Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Clinical Guidance for the management of blood glucose for adults with diabetes whilst in hospital Diabetes Blood Glucose RCHT CPFT KCCG Medical Director Date revised: 13/01/18 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Clinical guideline for the Management of Blood Glucose and Hyperglycaemia in Hospital for Adults with Diabetes V1.1 Diabetes In-Patient Specialist Nurses, Consultant Endocrinologists, Consultant Physician Medical Admission Roz Davies t Required {Original Copy Signed} Internet & Intranet Intranet Only Clinical / Endocrine and Diabetes Links to key external standards DoH:NSF Diabetes 2001 standard 8 4 of 8

5 Related Documents: Training Need Identified? ne Version Control Table Date Version 28 Jan 15 V1.0 Initial Issue Summary of Changes 19 v 15 V1.1 And Hyperglycaemia added to title 23 Mar 18 V2.0 IV insulin infusion added for B/G > 33 Changes Made by (Name and Job Title) Amanda Veall, Lead Diabetes Specialist Nurse Amanda Veall, Lead Diabetes Specialist Nurse Amanda Veall Lead Diabetes Specialist Nurse All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. 5 of 8

6 Appendix 2. Initial Equality Impact Assessment Form Name of the strategy / policy /proposal / service function to be assessed Management of Blood Glucose and Hyperglycaemia in Hospital for Adults with Diabetes Clinical Guideline V2.0 Directorate and service area: Endocrinology Name of individual completing assessment: Amanda Veall 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Is this a new or existing Policy? Existing Telephone: To provide detailed guidance on the clinical management of blood glucose for adults with diabetes admitted to secondary care 2. Policy Objectives* To provide a consistent approach to the management of blood glucose for adults with diabetes within Secondary care To maintain patient safety and improve outcomes for adults with diabetes within secondary care 3. Policy intended Consistent management of blood glucose in RCHT sites Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a Who did you consult with b). Please identify the groups who have been consulted about this procedure. Audit Datix Reporting Review of medical/ nursing documentation as required All adult patients with diabetes in RCHT Workforce Patients Local groups Please record specific names of groups Consultant Endocrinologists Consultant Physician Medical Admissions Diabetes Specialist Nurses External organisations Other What was the outcome Approved by all of the consultation? 7. The Impact Please complete the following table. If you are unsure/don t know if there is a negative impact you need to repeat the consultation step. Are there concerns that the policy could have differential impact on: Equality Strands: Unsure Rationale for Assessment / Existing Evidence Age Sex (male, female, trans-gender / gender reassignment) 6 of 8

7 Race / Ethnic communities /groups Disability - Learning disability, physical impairment, sensory impairment, mental health conditions and some long term health conditions. Religion / other beliefs Marriage and Civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked in any column above and consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major this relates to service redesign or development 8. Please indicate if a full equality analysis is recommended. 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission 20/04/2018 Names and signatures of members carrying out the Screening Assessment 1. Amanda Veall. DSN Lead 2. Human Rights, Equality & Inclusion Lead Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD This EIA will not be uploaded to the Trust website without the signature of the Human Rights, Equality & Inclusion Lead. A summary of the results will be published on the Trust s web site. Signed Amanda Veall Date 20/04/ of 8

8 8 of 8